Hallelujah!

According to The Independent, Midwives told they must respect mothers who decide not to breastfeed:

Mothers who decide not to breastfeed their child must be respected for their choice, midwives are being told.

New advice from the Royal College of Midwives (RCM) stresses new mothers should be given appropriate support if they make an informed decision to bottle feed…

[T]he RCM acknowledges some mothers struggle to start or carry on breastfeeding, breastfeeding, and says the decision is a woman’s right.

Think about that for a minute:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The RCM has just publicly acknowledged what Joan Wolf, Courtney Jung, Suzanne Barston, Christie del Castillo-Hegyi, Jody Segrave Daly, and I have been writing for the past decade.[/pullquote]

• The physiology of breastfeeding has not changed. A significant proportion of women have ALWAYS struggled to breastfeed.

• Women’s right to control their own bodies has not changed. Bottle feeding has ALWAYS been a women’s right.

• Midwives’ ethical obligations have not changed. Midwives were ALWAYS ethically required to respect women’s feeding choices.

This is an admission that they and the rest of the breastfeeding lobby — La Leche League, the Baby Friendly Hospital Initiative, professional lactivists in the World Health Organization — have spent the past decade IGNORING and DENYING women’s struggles and babies’ suffering, IGNORING and DENYING women’s rights, IGNORING and DENYING their ethical obligation to respect women’s choices.

Gill Walton, new head of the RCM essentially acknowledges their woeful behavior:

“…[S]ome women cannot or do not wish to breastfeed”.

“They must be given all the advice and support they need on safe preparation of bottles and responsive feeding to develop a close and loving bond with their baby,” Ms Walton added.

We know that 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.”

This is EXACTLY what Joan Wolf, Courtney Jung, Suzanne Barston, Christie del Castillo-Hegyi, Jody Segrave Daly, and I have been writing for the past decade.

Why is the RCM suddenly acknowleding what everyone has known for years? I suspect it’s because the power of the breastfeeding lobby has come up against the tremendous suffering and massive amount of healthcare spending their unethical behavior has caused. Babies are injured and dying from dehydration, jaundice and falling from or being smothered in their mothers’ hospital beds. Breastfed babies are being admitted to the hospital at twice the rate of their formula fed peers, costing hundreds of millions of healthcare dollars per year. Moreover, women are vocally opposing both the scientific claims and the unethical tactics of the breastfeeding lobby.

As I have noted in the past, the unethical behavior of the breastfeeding lobby can be traced to a seminal 1996 paper by lactation consultant Diane Weissinger who set out a roadmap of lactivist behavior. She proposed the use of shaming language to pressure women into breastfeeding.

Why?

She couldn’t have made it clearer:

All of us within the profession want breastfeeding to be our biological reference point. We want it to be the cultural norm; we want human milk to be made available to all human babies, REGARDLESS OF OTHER CIRCUMSTANCES. (my emphasis)

Regardless of the fact that up to 15% of first time mothers cannot produce enough breastmilk; regardless of the fact that many women don’t want to breastfeed; regardless of women’s right to control their own bodies and midwives’ ethical obligation to support women’s choices.

The breastfeeding lobby — despite endlessly whining of victimhood — has controlled the infant feeding discourse with an iron fist for the past decade and more.

Sociologists Sunna Símonardóttir and Ingólfur V. Gíslason explain that women have been challenging the power of the breastfeeding lobby.

How?

Mothers pointed out that formula fed children are healthy.

The most uncontested and culturally accepted type of medical discourse on breastfeeding is the long list of the assumed benefits on the health and wellbeing of children…

Even though the women do not directly challenge this overall assumption, or make claims that breastmilk has no health benefits over formula, some of them do contest certain aspects of the hegemony of the medical breastfeeding discourse. The women who challenge the medical discourse on breastfeeding do so from a personal standpoint, contrasting their own happy and healthy children with the image of formula fed children as deprived and less healthy.

Their formula fed children are smart:

For some of the women, the worst aspect of this medical discourse on the benefits of breastfeeding is the notion that breastfeeding has a positive effect on a child’s intelligence. The women stress the academic achievements of their children and how in fact their formula fed child is ‘top of the class’.

They and their children have bonded fiercely to each other:

Breastfeeding … has been constructed as a vital aspect of mother–child bonding, reflecting the ideology of intensive mothering and ‘the need for mothers to manage risk by heeding expert warnings and advice.’ A number of women reject this idea that bonding takes place through breastfeeding by discussing the effects that breastfeeding (or trying to breastfeed) had on their mental and psychological wellbeing. Those women had usually been trying to establish breastfeeding with a lot of difficulty and severe pain, and they describe trying to breastfeed as an ‘emotional roller-coaster’ that has had serious consequences and often made them feel depressed and anxious. Breastfeeding is therefore not constructed as helpful when it comes to bonding, but directly harmful to the bonding process.

Women found that most of the ostensibly scientific claims made about breastfeeding were not true in their circumstances. That’s hardly surprising since, as I and others have detailed repeatedly, most of the scientific claims made about breastfeeding were made as part of the Panglossian paradigm beloved of both lactivists and anti-vaxxers that nature is perfect and technology cannot improve upon it.

The scientific evidence about breastfeeding has always been weak, conflicting and riddled with confounding variables. Early claims about the benefits of breastfeeding have not been borne out by later, larger studies. Most importantly, none of the predicted public health benefits of breastfeeding (based on mathematical modeling) have occurred; there have been no measurable changes in the mortality and morbidity rates of term infants and no healthcare dollars saved. To the contrary, the results of the power of the lactivist lobby are best measured in infant deaths and disabilities, maternal anguish, and hundreds of millions of dollars spent each year treating breastfeeding complications.

What the findings of this study do is to make visible certain discursive constructions and power relations that have remained hidden or simply taken for granted. Once they have been identified, we are much better equipped to disrupt and untangle these constructions and power relations and critically engage with the normalizing discourses on infant feeding …

Is this, as Guardian columnist Zoe Williams asks, the end of the breastfeeding wars?

I doubt it for the reason that Williams herself details: privilege.

The underlying issue was class-based: breastfeeding, the middle-class choice, gave middle-class parenting a superior status that would otherwise have been difficult to assert… [T]he First Three Years became a key policy area, with improbable and unpleasant assertions about what non-U parents were like. They fed their babies formula, then they left them all day strapped into a buggy, pointed at a wall; they didn’t give them the right vocabulary because they weren’t interested in talking to them. Bottles became a key signifier of parental neglect …

It’s was never about babies, but always about mothers:

This has been a culture war, and quite an exhausting one, where nothing meant exactly what it said: the pro-breastfeeding line originated with second-wave feminism, asserting a woman’s choice to feed with her baby as she saw fit, without medical or corporate interference. That liberation became an oppression; if it’s the only thing you’re allowed to choose, that’s not a choice. It fed into a set of ideas that located the source of childhood disadvantage not in hardship but in their parents’ sub-optimal behaviour, so that poverty would indicate, literally, that if you weren’t a bad person then probably your mother was. And this political notion was mediated not just through women’s bodies but through our actual tits. It was faintly chilling for all women, mothers or not. It would be wonderful if the RCM’s humane, good sense intervention marked the end of it.

It would be wonderful, but I predict that the breastfeeding lobby is not going down without a fight. There will be wailing and gnashing of teeth: about Nestle, about victimhood and about “The Science.” There will be no mention of the fact that breastfeeding is a big business, bringing in billions of dollars of revenue in breastfeeding products, and probably much more in lactation consultant fees and salaries.

Winston Churchill’s words about actual war may apply to the breastfeeding wars.

Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.

“Unvaccinated is the biological norm for human beings.

Natural immunity, the sole source of infant/child immunological protection in nature, has evolved as a result of 200 million years of Darwinian pressure to become the perfect defense against disease.

When we move away from this biological norm, it is up to us to research the effects of this, and this puts the onus on vaccines to show there is no risk associated with its use. Just as we examine the risks of other changes to our biology, like a diet filled with fast food (again, we don’t speak of the “benefits” of avoiding McDonalds), the same holds for vaccination. Or rather, should hold. The fact that it doesn’t speaks to the power of Big Pharma and the societal push for vaccines to be seen as the norm.

The vast majority of vaccines research has treated vaccines as something that can be done outside this biological norm and still confer “benefits”. That can’t possibly be true.”

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactivists treat breastfeeding like antivaxxers treat natural immunity.[/pullquote]

Typical anti-vax nonsense, right?

While unvaccinated is indeed the biological norm, we can do better than nature. Limited to only natural immunity, infants and children become ill and die in droves.

As this impressive graphic shows, both cases and deaths from vaccine preventable diseases have dropped dramatically with the introduction of vaccines.

There has been literally a 100% drop in deaths from diphtheria, a 100% drop in deaths from polio, a 100% drop in deaths from rubella and smallpox, previous a dreaded disease, was eliminated altogether.

Unvaccinated may be the biological norm for infants and children but deaths from vaccine preventable diseases are also the biological norm. Natural immunity is indeed the product of hundreds of millions of years of evolution, but that didn’t make it perfect or even close to perfect. While there are certainly benefits to natural immunity (it can be longer lasting than vaccine induced immunity), there are also considerable risks. In order to acquire natural immunity, you have to survive the disease and many don’t.

In the case of vaccine preventable disease, nature is good, but technology is better, safer and far more convenient. You’d have to be kidding yourself to pretend otherwise.

Now I have a confession to make:

The above quotes, while typical of antivax beliefs, do not come from antivaxxers. They come from lactivists. I merely substituted vaccine rejection for breastfeeding.

It was easy to do because the claims lactivists make about breastfeeding mirror the claims antivaxxers make about natural immunity. In both cases they represent wishful thinking, not reality and are based on the belief that natural selection creates the best possible outcome.

This view was derided by evolutionary biologist Stephen J. Gould as the Panglossian paradigm. The paradigm references Pangloss, a character in Voltaire’s Candide who believes that “all is for the best in this best of all worlds.” In the context of evolution the Panglossian paradigm imagines that everything that exists in nature today is the product of intense natural selection and represents the perfect solution to a particular evolutionary problem.

In the case of immunity the Panglossian paradigm insists that natural immunity represents the perfect solution to the evolutionary problem of disease. In the case of breastfeeding the Panglossian paradigm insists that breastfeeding represents the perfect solution to the problem of infant nutrition.

Science blogger Josh Rosenau explains Gould’s seminal paper written with Richard Lewontin, “The Spandrels of San Marcos and the Panglossian Paradigm: A Critique of the Adaptationist Program.”

The point was that biologists were too quick to insist that every feature was adaptive and a result of natural selection. Spandrels are triangular structures produced when two round arches meet. They are necessary byproducts of joining rounded and flat surfaces. Nonetheless, in many churches they are richly decorated and the entire artistic vision for a space can be shaped by the spandrels. One might, Gould points out, be lead to think that the spandrels are there in order to be used for paintings, and not that they are necessary by-products nicely dressed up. The worldview he criticizes treats anything, whether spandrels or five fingers, as the product of intense selection, a perfect solution to the problems it faces.

In other words, an existing natural feature, whether immunity or breastfeeding, may not be the result of evolutionary pressure, it may be an incidental feature of a solution to an entirely different problem or it may represent the limits of genetic adapatation. For example, it would undoubtedly be evolutionarily advantageous to have eyes in the back of our heads yet we never developed them. Instead technology gave us mirrors, which we can use to escape our biological limitations and see behind us. Two eyes don’t represent the best of all possible outcomes, merely the outcome that we have.

Nature is NOT perfect and therefore technology can improve upon nature.

It’s easy to see the limits of the Panglossian paradigm in immunity. Natural immunity is clearly deficient and involves a massive amount of disease and death. Just as rear view mirrors allow drivers to escape the limitations of only two forward facing eyes, vaccines allow us to escape the limitations of an immune system that requires us to be exposed to a deadly pathogen (and possibly die) in order to become immune.

It’s harder to see the limits of the Panglossian paradigm in breastfeeding because lactivists and their organizations have spent dozens of years and millions of dollars explicitly denying the limitations of breastfeeding. They’ve resorted to lying in order to do so: lying about the high failure rate of breastfeeding due to insufficient breastmilk, lying about the high complication rate from dehydration or jaundice and lying to exaggerate the benefits of breastfeeding. They lie not out of malice but out of a deeply held belief in the erroneous Panglossian paradigm that evolution produces the “best of all possible world” when it merely produces survival of the fittest. They assert that formula cannot possibly be as good as breastmilk when the reality is that it, like vaccines, could ultimately be better, safer and more convenient because we can often improve upon nature.

Breastfeeding may represent the result of hundreds of years of evolution but evolution does not produce perfection. Lactivists who refuse to recognize their error are no different from antivaxxers who refuse to recognize the same error.

What do lactivists and antivaxxers have in common? Neither truly understands the limitations of evolution, and lacking that understanding make extravagant and false claims about the virtues of the biological norm.

The headline, Infant formula could change gut bacteria, contribute to childhood obesity, is alarming.

The findings are worrisome:
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]If they had used a growth chart of how all infants grow, not merely breastfed infants, the title might easily be ‘Exclusive Breastfeeding and the Risk of Underweight in the First Year of Life.’[/pullquote]

A new study shows that babies who were breastfed had different bacteria environments, or microbiomes, in their guts –- and lower obesity levels as they grew -– than babies who were primarily fed formula…

For the study, published in the Journal of Pediatrics [sic], researchers in Canada looked at data from the Canadian Healthy Infant Longitudinal Development, or CHILD, focusing on the first year of life for more than 1,000 infants from four different sites.

Researchers in this study wanted to know if only breastfeeding, breastfeeding plus some early foods, or formula feeding alone affected the type of bacteria found in the infants’ guts at two ages: 3 to 4 months and 12 months.

What did they find?

Of the formula-fed babies, 33 percent were overweight or at risk of being overweight, while 19 percent of exclusively breastfed babies were overweight or at risk.

There’s a serious problem with the study, however. It uses a flawed and arbitrary measure of infant obesity.

The paper is Association of Exposure to Formula in the Hospital and Subsequent Infant Feeding Practices With Gut Microbiota and Risk of Overweight in the First Year of Life.

The authors report:

There were 1087 infants in the study (507 girls and 580 boys); at 3 months, 579 of 1077 (53.8%) were exclusively breastfed according to maternal report. Infants who were exclusively formula fed at 3 months had an increased risk of overweight in covariate-adjusted models (53 of 159 [33.3%] vs 74 of 386 [19.2%]; adjusted odds ratio, 2.04; 95% CI, 1.25-3.32). This association was attenuated (adjusted odds ratio, 1.33; 95% CI, 0.79-2.24) after further adjustment for microbiota features characteristic of formula feeding at 3 to 4 months …

Here is a chart of the results.

How did they determine which babies were “obese”?

At 12 months of age (mean [SD] age, 12.4 [1.3] months), infants were weighed and measured by CHILD Study staff. Age- and sex-specific weight for length z (WFLz) scores were calculated according to World Health Organization standards. A WFLz score greater than the 97th percentile was considered overweight, and a WFLz score greater than the 85th percentile was considered at risk for overweight …

But breastfed babies and formula fed babies grow differently. The CDC acknowledges:

The WHO growth charts reflect growth patterns among children who were predominantly breastfed for at least 4 months and still breastfeeding at 12 months. These charts describe the growth of healthy children living in well-supported environments in sites in six countries throughout the world including the United States. The WHO growth charts show how infants and children should grow rather than simply how they do grow …

The WHO growth charts establish the growth of the breastfed infant as the norm for growth. Healthy breastfed infants typically put on weight more slowly than formula fed infants in the first year of life. Formula fed infants gain weight more rapidly after about 3 months of age. Differences in weight patterns continue even after complementary foods are introduced

Wait, what? Formula fed infants are being evaluated on a scale designed for breastfed infants?

To understand why that’s a serious problem it’s instructive to consider the genesis of the current WHO standards. Previous standards evaluated growth based predominantly on formula fed infants since most infants were formula fed at the time they were developed. Many breastfed infants were diagnosed as underweight using these charts. Breastfeeding advocates claimed that it was wrong to evaluate breastfed infants using formula fed infants as the standard.

They had a point, but it’s not clear that it was a valid one. It’s based on the assumption that every breastfed infant is fully fed when the reality is that breastfeeding has a significant failure rate and some breastfed babies are actually underfed. Far fewer babies receiving formula are underfed since they can eat until satiety instead of merely until the milk runs out.

The WHO charts purportedly show “how infants and children should grow rather than simply how they do grow.” But they don’t measure how infants “should” grow, they measure how breastfed infants, including underfed infants, grow. It’s a classic example of the naturalistic fallacy: if something is a certain way in nature, that’s how it ought to be. But that’s makes as much sense as constructing a child growth chart including those with rickets to evaluate contemporary children who have easy access to calcium and vitamin D.

It’s not clear at all that any of the purportedly obese infants in this study would be considered obese if the authors used a growth chart of how all infants grow, not merely breastfed infants. In that case, the title of the study might be ‘Exclusive Breastfeeding and the Risk of Underweight in the First Year of Life.’

This paper is yet another example of white hat bias.

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

Breastfeeding researchers are so sure that breastfeeding is beneficial, and are so hostile to the infant formula industry that they arrange their data in ways that promote breastfeeding and demonize formula. Creating and employing infant growth charts that assume that breastfeeding is always best for every baby is bias in the service of what are perceived to be righteous ends. But it’s bias nonetheless and it’s wrong.

And that makes the conclusion of this study entirely arbitrary.

Breastfeeding initiation rates in the US are the highest they have been in nearly 50 years.

As this chart from the Surgeon General’s Call to Action on Breastfeeding demonstrates, the rise has been dramatic, tripling from 1970 to 2007:

But you’ll also notice that breastfeeding rates fell off dramatically by 6 months both in 1970 and all the way through 2007. The number of women breastfeeding exclusively at 6 months is only a tiny fraction of those who had been breastfeeding at birth. The proportion of women breastfeeding at 12 months was only half the rate of women breastfeeding at 6 months.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Facing intense pressure, women who have no particular commitment to breastfeeding as well as those who have no intention to breastfeed, are forced to lie.[/pullquote]

The most recent data I could find shows that from 2011 to 2015 79.2% of mothers initiated breastfeeding, 20% were exclusively breastfeeding at 6 months, and 27.8% of mothers were still offering some breastfeeding at one year. The dramatic drop off is common at all maternal ages, all ethnicities, and every education and economic level. College graduates have the highest breastfeeding rates across the board: 91.1% at birth, 27.7% exclusively at 6 months, and 40.3 offering some breastmilk at a year.

Lactation professionals look at these numbers and insist (without any evidence of any kind) that the dramatic drop off in breastfeeding rates is due to “lack of support” for breastfeeding.

I look at these rates and reach a very different conclusion: there’s a whole lot of lying going on.

The foundational lie is the insistence that nearly every woman (once she is properly “educated”) wants to breastfeed.

The truth is that aggressive breastfeeding promotion efforts have become the norm in industrialized countries led by poorly named Baby Friendly Hospital Initiative that isn’t remotely friendly to babies and ignores mothers altogether. Ugly tactics — locking up formula, making women sign consent forms for formula, forcing lactation consultants on everyone — have become standard practice. There is tremendous pressure on hospital staff to increase breastfeeding rates at discharge and that pressure is transferred unabated to mothers. In the face of that pressure, women who have no particular commitment to breastfeeding as well as those who have no intention to breastfeed, are forced to lie.

A piece in yesterday’s Nursing Times, Changing the conversation around breastfeeding, notes:

In the UK, 81% of women initiate breastfeeding at birth but within the first day, exclusive breastfeeding has dropped to 69% – and down again to less than 50% by the end of the first week.

…[W]hy are so many women who want to breastfeed stopping before they would choose?

I suspect that they didn’t want to breastfeed at all; they merely said they did in order to stop the endless harangues from midwives, nurses and lactation consultants. No one who truly intends to breastfeed drops it after only one day. They obviously were not committed to it in any meaningful way. They just said they wanted to breastfeed to get the staff off their backs.

Moreover, there’s no guarantee that the breastfeeding rates at 6 months and one year are accurate. They are the results of reports by women, women who know that it is more socially desirable to claim to be breastfeeding, therefore they are likely to be inflated. If that’s the case, the drop off in breastfeeding rates is even more stark than advocates claim.

The other lie beloved of lactivists is that the difference between breastfeeding success and failure is support for breastfeeding.

There has arguably never been more support for breastfeeding in the past 100 years yet breastfeeding rates still drop off dramatically over time. Judging by the graph I posted above, breastfeeding support makes no difference to breastfeeding rates. While breastfeeding rates at 6 months and 12 months have risen over time, that reflects the fact that more women initially decided to try breastfeeding. The proportion of women who stop between birth and 6 months remains nearly unchanged. That suggests that factors other than support are responsible for the dramatic drop off.

These factors include the intrinsic failure rate of breastfeeding (up to 15% of first time mothers will not produce enough breastmilk in the early days), pain, frustration and inconvenience. Moreover, nearly every woman knows many people who were formula fed and they turned out just fine. No matter how often and how loud lactivists blare the purported benefits of breastfeeding, it is pretty obvious that most of those benefits are illusory.

What explains the dramatic difference in extended breastfeeding between college graduates and everyone else? Of women without college degrees only approximately 20% are breastfeeding at one year while 40% of college graduates are still doing so. I suspect that both structural factors and priorities are responsible for the difference. The structural factors include access to maternity leave and jobs compatible with pumping. In addition, many women with college degrees have made reaching the one year mark of breastfeeding a priority; they are achievement oriented to begin with and breastfeeding to one year has been promoted to them as an achievement.

What do breastfeeding rates tell us about breastfeeding promotion efforts? They have been successful in increasing initial breastfeeding rates though a significant proportion of the increase is illusory since it represents women lying about their intentions. They indicate that ongoing breastfeeding support has little to nothing to do with breastfeeding rates. Though the absolute number of women breastfeeding at 6 and 12 months has risen, the proportion of those who initiate breastfeeding who are still breastfeeding at 6 and 12 months has not changed; the majority of women still quit.

We’ve spent millions of dollars promoting breastfeeding, but what do we have to show for it? Not much. Yes, breastfeeding rates have risen, though far less than it appears. There’s no evidence that it has saved lives (with the exception of extremely premature infants) and no evidence that it has saved money, let alone returned the investment.

We’ve conducted a massive social experiment and virtually none of the promised results have occurred. And we’ve turned new mothers into liars. That doesn’t sound like success to me.

I just came across a post on Reddit that perfectly captures the negativity about Fed Is Best (the Foundation and the philosophy). It’s entitled Sick of the negativity about breastfeeding.

The writer whines:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Mothers should make feeding decisions based on infants’ need for food, not lactivists’ wish to be admired.[/pullquote]

This is a throwaway rant about how people who don’t breastfeed feel the need to constantly talk down about it, try to argue and minimize the health benefits …

I’m just sick of it. I worked HARD to EBF my 15 week old who wouldn’t latch. I pumped and tried a nipple shield in between. Met with LCs, had engorgement, nipple pain, etc…

I pushed through because BFing was something that was personally important to me…

I’m proud to say he’s been EBF for his entire life – a little over 15 weeks and I see no slowing down in sight. BFing is not for everyone and that’s totally fine but this is a personal achievement that mattered to me.

To understand just how obnoxious this is, consider a parent whining about other parents who send their children to community colleges:

This is a throwaway rant about how people whose children don’t attend prestigious colleges feel the need to constantly talk down about it, try to argue and minimize the benefits.

I’m just sick of it. I worked HARD so my children could get the best educations possible and sacrificed spending on myself to save for college.

I pushed through because my children getting prestigious degrees was something that was personally important to me.

I’m proud to say all of my children attended highly ranked colleges. The Ivy League is not for everyone and that’s totally fine for those who think community college is acceptable but this is a personal achievement that mattered to me.

Why is that so unattractive?

It reduces something that is supposedly a gift to your children to a personal triumph.
It negates the possibility that an Ivy League education is not right for every child.
It demeans the accomplishment of graduating from community college.
It is poorly disguised self-aggrandizement

The writer continues in the same peevish, small minded fashion:

Every time I go on /beyondthebump there’s post after post about the misery of BFing and god forbid you defend it. Same thing in real life with my friends who FF.

I am 100% in the camp of fed is best, IDGAF how you feed your baby but could you imagine if we crapped all over FFing like they do to BFing? We’d be accused of being sanctimommies who think they’re better than everyone else.

In short – yes I BF my baby, no I don’t care or judge how you feed yours but please don’t tell me I’m wasting my time and energy and share illegitimate blog articles trying to downplay BFing benefits.

That’s like:
I constantly meet friends who wail about being unable to afford high cost of prestigious college degrees for their children.

I am 100% in the camp of doing what you can afford and what you think your child needs; IDGAF where you send your child, but could you imagine if we all crapped over community colleges the way they disparage the Ivy League? We’d be accused of being sanctimommies who think they’re better than everyone else.

In short – yes I sent my children to prestigious colleges; no – I don’t care or judge settling for community colleges but please don’t share illegitimate blog articles trying to downplay the benefits of the Ivy League.

Ugly, right?

The hypocrisy of claiming that you are not disparaging formula while simultaneously implying it is inferior is totally lost on the author. The insistence that she doesn’t care how other women feed their babies when she is completely obsessed with how other women feed their babies is bizarre. And the way she turns the choices of other women into a referendum on HER choices is incredibly self-absorbed.

The author has what we might call in other circumstances a conflict of interest. She cannot look dispassionately at the risks of breastfeeding or the benefits of formula because her ego is involved. She wants to believe that her decision to breastfeed is heroic, even though it is basically irrelevant to the health and well being of her child. She needs other women to admire her for her heroism when they have as little interest in how she feeds her baby as in what car she drives.

Women who choose to formula feed have different priorities than those who insist on breastfeeding despite the fact that their child is starving and they are suffering. The Fed Is Best Foundation created a meme that brilliantly lays out their priorities.

Top Priorities of Newborn Feeding
1. Protecting a newborn’s life
2. Protecting a newborn’s brain and vital organs
3. Protecting a newborn from disability and lower academic achievement
4. Protecting a newborn from hospitalization for feeding complications
5. Protecting a newborn from hunger, thirst and suffering
6. Protecting the newborn patient and human rights
7. Protecting a mother’s right to choose and to feed her hungry baby

Low Priority
Protecting the newborn from a single drop of formula
Protecting a newborn’s exclusive breastfeeding status at discharge.

Notice what’s not a priority at all:
Protecting a mother’s desire to feel superior to other mothers.

The negativity about Fed Is Best is clear evidence that breastfeeding advocates have failed to get their priorities straight. Infant feeding is not about them and their egos; it’s about babies and nourishment. Mothers should make their decisions based on infants’ need for food, not lactivists’ wish to be admired.

Whether breastfeeding advocates believe it or deny it, fed is truly best!

When one of my sons was four years old, he made a decision. He told me, “I’m never going to work as much as Daddy! He works too hard.”

My son did eventually become a lawyer like his father, but he avoided big firm law, choosing a job with lower pay but much better hours as well as the opportunity to serve the public. He’s quite willing to work hard, but he doesn’t want to be available to the office and to clients 24/7/365.

I thought of him when I read that the US birth rate has dropped to its lowest level in 30 years and may be heading down farther.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The pressure on mothers to parent “naturally” was supposed to force them back into the home; instead they’re rejecting mothering.[/pullquote]

I wonder if we have made motherhood look too hard.

According to NPR:

The birthrate fell for nearly every group of women of reproductive age in the U.S. in 2017, reflecting a sharp drop that saw the fewest newborns since 1987, according to a new report by the Centers for Disease Control and Prevention.

There were 3,853,472 births in the U.S. in 2017 — “down 2 percent from 2016 and the lowest number in 30 years,” the CDC said.

That reflects a drop in nearly every age group:

Broken out by age, the 2017 birthrate fell for teenagers by 7 percent, to 18.8 births per 1,000, a record low. That figure is for women from 15 to 19 years old. For that same group, the birthrate has fallen by 55 percent since 2007 and by 70 percent since the most recent peak in 1991, the CDC said.

Women in their 40s were the only group to see a higher birthrate last year. Between the ages of 40 and 44, there were 11.6 births per 1,000 women, up 2 percent from 2016, according to the CDC’s provisional data.

Birthrates fell by 4 percent both for women from 20 to 24 years old and for women of ages 25 to 29.

For women in their 30s — a group that had recently seen years of rising birthrates — the rate fell slightly in 2017. The drop included a 2 percent fall among women in their early 30s, a group that still maintained the highest birthrate of any age group, at 100.3 births per 1,000 women.

Why is this happening?

Some claim it reflects long term demographic shifts common to all industrialized countries.

Others claim that it is the fault of the patriarchy: the lack of maternity leave forces women to choose between being good mothers or good workers, sure that they can’t be both.

Still others insist that it represents a rebuke to the patriarchy. Women no longer buckle under the societal pressure to have children and are childless by choice.

I fear we may have “broken” motherhood.

I’ve written repeatedly about my belief that the political and legal emancipation of (some) women in the 20th Century was a watershed moment in history. For the first time women were able to assert the exact same rights as men. They went from being property to property owners. They went from being economic chattel to economic engines. They were finally able to express themselves in the political, technological and artistic realms.

And that made some people very, very unhappy.

No major social change occurs without backlash and we are currently living through the backlash. On the Right there has been a rise of religious fundamentalism that insists that God wants women to be subjected to men, immured in the home and occupied only in the raising of children, often many, many children. On the Left there has been a rise of secular “religion,” the worship of Nature. Women (though not men) are pressured to raise their children the way Nature intended. And Nature supposedly intended them to give birth with excruciating pain (epidurals are “bad”); breastfeed each child exclusively for years (formula is “bad”); and literally “wear” babies on their bodies (a mother who considers her own needs is very “bad”).

Being a mother was always hard, but now the pressure on new mothers is extraordinary. How extraordinary? Consider a tweet posted several days ago by Carole Dobrich.

Dobrich is a lactation professional:

Carole is the Senior Lactation Consultant and co-director at the Herzl Family Practice Centre – Goldfarb Breastfeeding Clinic where she works with a team of IBCLCs and family physicians trained in lactation… Carole is the past president of the association québécoise des consultantes en lactation diplômées de l’IBLCE (2004 – 2008) and is the current president of INFACT Quebec and is actively involved in breastfeeding advocacy work in Quebec, Canada and internationally.

She chose to share a slide from a recent conference:

The slide claims:

Children will never achieve their full genetic potential by starting post partum life with ingesting a pediatric fast-food prepared from the milk of an alien species.

That’s just gratuitous cruelty masquerading as breastfeeding promotion. It’s using guilt to force women back into a very constricted and constricting definition of motherhood.

As psychologist Susan Franzblau has written:

The idea that women are evolutionarily prepared to mother … is consistent with a long historical tradition of using essentialist discourse to predetermine and control women’s reproductive tasks and children’s rearing needs. Evolutionary and biological theories have been embedded in a history of misogynist discourse… Women’s “natural” function … is to reproduce and provide continual care for infants and young children. If the treatment of women differs from the treatment of men, such treatment could be justified in terms of its biological and evolutionary purposes…

It is not a coincidence that natural mothering neatly dovetails with religious fundamentalism:

Organizations such as the Christian Family Movement (established by the Catholic laity …) became the founders of the La Leche League in 1956… According to one natural childbirth advocate of the time, “childbirth is fundamentally a spiritual as well as a physical achievement …” Breastfeeding was heralded as an extension of this spiritual connection. Out of concern that recently instituted bottle-feeding and drug-assisted births would break family bonds, these religious advocates of breastfeeding prescribed a regimen that included suckling on demand day and night with no pacifier substitute … Any work that competed with the infant’s need for continuity of maternal care was out of the question. One La La Leche League International group leader said that she was “pretty negative to people who just want to dump their kids of and go to work eight hours a day.”

The pressure on mothers to parent “naturally” was supposed to force them back into the home; and for many women the artificially imposed guilt about “what children need” left women competing with each other about who suffered more for her children instead competing with men for economic equality in the workplace.

But now a new generation of women face this false choice and they are choosing differently. Having seen how their mothers and older sisters suffered to meet the ever more elaborate “requirements” for contemporary mothers they are choosing to forgo childbearing altogether. They don’t want to work as long and as hard on mothering as parenting experts prescribe. They don’t want to endure the guilt of failing to meet the arbitrary standards of good mothering. They like children but they don’t want the apparently crushing responsibility that comes with bearing them. Mothering is broken and as a result, they want no part of it.

Who broke mothering?

Advocates of natural childbirth, exclusive and extended breastfeeding, and attachment parenting broke it. Our country is going to pay a terrible price as a result. If the birth rate remains below replacement level our society will age dramatically, our social welfare programs like Social Security will fall apart and there will be no one to take care of us when we grow old.

But, hey, even though there will be far fewer children, at least they’ll be breastfed, right?

I read a terrific new book this weekend, Bad Blood: Secrets and Lies in a Silicon Valley Startup.

John Carreyrou of the Wall Street Journal tells the story of Theranos, a company with a brilliant idea that promised a revolution in healthcare but ended up as a billion dollar scam that delivered nothing.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]When will we accept that the claims of breastfeeding advocates were always too good to be true?[/pullquote]

It reminded me of breastfeeding.

Theranos was the brain child of Elizabeth Holmes, who dropped out of Stanford at 19 to create it, a needle-phobe who envisioned running hundreds of blood tests using a single drop of blood drawn from a finger stick.

It was an idea that was too good to be true — literally. But Holmes would not, could not admit the truth even though it became clear early on that her vision was a physical impossibility. Despite what her engineers were telling her, Holmes doubled down again and again: 200 test results from a single drop of blood became 800; the number of companies supposedly using her test successfully multiplied while in reality no one was using it; most egregiously, she faked test results and offered those results as real. Along the way, naysayers were fired and silenced with iron clad non-disclosure and non-disparagement agreements.

Theranos was the healthcare version of “vaporware”: software announced with great fanfare, promising the moon to secure massive outside investment, but ultimately delivering nothing but misery and bankruptcy. Breastfeeding is another healthcare version of vaporware, promising extraordinary savings in lives and healthcare dollars, endlessly touted to secure ever larger outside investment, but ultimately delivering more than its share of misery and medical illness.

The claims about breastfeeding have always been too good to be true. It has been promoted as the “perfect” food for newborns when we know that nothing in nature is perfect. It has been promoted as lifesaving when we know that for most of human existence all infants were breastfed and they died in droves and though contemporary countries with the highest breastfeeding rates have the highest infant mortality rates. It was promoted to solve a problem that was fundamentally misrepresented. Babies died in Africa as a result of Nestle’s greed in encouraging African women to formula feed. But the problem was never the formula; it was the contaminated water used to prepare it.

The similarities don’t end there. Elizabeth Holmes had a wonderful vision of hundreds of tests from a single drop of blood and she was determined to “fake it until you make it.” She really believed that if she could dream it, she could make it happen. She would not compromise her vision merely because reality got in the way.

For the past 40 years or so professional lactivists have had a wonderful vision of every baby being breastfed and surviving until old age because of it. They really believed that if they could dream it, they could make it happen. They refuse to compromise their vision merely because reality gets in the way. The benefits don’t materialize and the risks keep mounting, yet they’re still trying to fake it until they make it.

Elizabeth Holmes sold many otherwise hard headed people on her vision to the tune of billions of dollars in investment. They believed in the dream; they wanted it to be true; and they were taken in by her lobbying efforts. Once a few prominent investors were on board, it was easy to recruit others. If former Secretaries of State Henry Kissinger and George Schultz were investing, it must be true! Others rushed to copy them.

Professional lactivists sold many healthcare professionals on their vision to the tune of millions of dollars. Lactivist lobbying initially swayed the World Health Organization and ultimately recruited the CDC, the American Academy of Pediatrics and the American College of OB-GYNs. If those eminent organizations were supporting breastfeeding, the claimed benefits must be true. Others rush to copy them. The Baby Friendly Hospital Initiative was created and welcomed into hospitals; it promised to increase breastfeeding rates and save money at the same time!

Elizabeth Holmes ran into problems early on; the product failed to perform. In response she began to fake results; testing blood on conventional machines back in company headquarters and wirelessly transmitting the results to her machines to make it look as though they were working. She continued to ignore the evidence brought to her by her staff that the product not only didn’t work but couldn’t work.

Breastfeeding advocates ran into problems early on; some women didn’t have enough breastmilk. In response, they began to lie, claiming insufficient breastmilk was rare when it is actually common. Then the touted benefits failed to appear. In response, they began promoting mathematical models which extrapolated weak, conflicting data riddled with confounders to make it look like the claims were true. Whenever new evidence appears that contradicts early claims, and it appears often, it is simply ignored.

When Holmes deployed her devices, they began to harm people by delivering faulty results. Holmes did not back down. She and her lawyers harassed and threatened the doctors and patients who complained.

Aggressive breastfeeding efforts are harming babies, increasing injuries and deaths from dehydration, jaundice and babies smothered in their mothers’ hospital beds. Professional lactivists have not backed down, dead babies be damned. Their organizations harass and demean founders and members of the Fed Is Best Foundation, accusing them of being in the pay of formula companies without even a shred of evidence to support those claims.

To this day Elizabeth Holmes maintains that her dream of hundreds of tests performed on a single drop of blood is possible and will happen. This despite the fact that she has been sanctioned by various government organizations, has seen her net worth drop from billions to zero, and may face criminal charges for fraud. She cannot be shaken from her conviction that merely imagining something is possible makes it possible.

To this day professional breastfeeding advocates repeat the claims of lifesaving benefits of breastfeeding without any risks. This despite the fact that babies have literally died from insufficient breastmilk and the closing of well baby nurseries, despite the scientific papers showing that most of the claimed benefits don’t really exist, and despite the utter failure to appear of touted improvements in lives and money saved. They cannot be shaken from the conviction that merely insisting breastfeeding is lifesaving makes it so.

One of the saddest incidents in Bad Blood occurs when Tyler Schultz, grandson of major Theranos investor George Schultz goes to work for the company. He quickly realizes Theranos is a scam that is harming patients. He quits, tells his grandfather what he’s learned and cooperates with the Wall Street Journal investigation. It destroys his relationship with his grandfather who refuses to believe that Holmes’ claims weren’t and couldn’t be true. Tyler Schultz is excluded from his grandfather’s 95th birthday party; Elizabeth Holmes is invited.

It remains to be seen how organizations and providers scammed by the breastfeeding industry react to the rising tide of data showing that breastfeeding saves neither lives nor healthcare dollars and may actually put both at risk. Will they reject the scientific evidence and the growing clamor from mothers of babies who have been harmed or will they accept reality that the claims of breastfeeding advocates were always too good to be true? Only time will tell.

It’s no surprise that a privileged, white natural childbirth advocate would deny my claim that white privilege plays a large role in natural childbirth advocacy. I am surprised, however, by the weakness of her denial.

As the title of her piece, The Obstetrician Who Cried “White Privilege”, indicates, history Prof. Lara Freidenfelds considers my claim irresponsible.

In December of 2016, I wrote an essay for Nursing Clio called Nurse-Midwives are With Women, Walking a Middle Path to a Safe and Rewarding Birth. In the piece, I advocated that all women be given the option of delivering with hospital-based nurse-midwives … I only recently, quite belatedly, realized that OB-GYN Amy Tuteur had responded on her blog to my essay. She offered a belittling (and inaccurate) representation of my position on hospital-based nurse-midwifery, specifically invoking the specter of “white privilege.” Why? As far as I can see, it was an attempt to shut me down with highly-charged language that was intended to shame me and alienate those likely to be my allies.

Well, yes, natural childbirth advocates ought to be ashamed that in their privilege they imagine that what all women need is what privileged white women want. For better of for worse, Prof. Freidenfelds is a perfect example of white, pregnancy privilege.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Who wants to be accused of being a privileged white person? Certainly not a privileged white person![/pullquote]

As I’ve written before, pregnancy privilege is defined by 25 attributes:

1. My pregnancy is planned and wanted.
2. I am healthy.
3. I have health insurance.
4. I have a choice of healthcare providers and do not have to rely on a clinic.
5. I can access a hospital that has excellent statistics for neonatal and maternal outcomes.
6. I can be sure that the majority of my caregivers belong to my racial and demographic group.
7. I speak English.
8. I am married or have a reliable long term partner who is available to care for me when needed.
9. I have easy access to and can afford healthy food.
10. I can afford books on pregnancy.
11. I can afford to take childbirth classes.
12. I may have to sacrifice, but if I wish I can afford a doula or midwife.
13. I can hire a birth photographer.
14. I can afford weeks or months of maternity leave from my job.
15. I have easy, reliable access to the internet so I can share information with other pregnant women.
16. I can write well enough to create a birth plan.
17. I am not a victim of domestic violence.
18. I am not addicted to alcohol or drugs.
19. If I have older children, I have family or friends to care for them when needed.
20. I can create a baby registry on the assumption that I and my friends can afford to purchase new baby items.
21. I can afford a breast pump.
22. I have a job that offers both privacy and time to pump without loss of income.
23. I have a spouse or partner who is supportive of breastfeeding.
24. I don’t face a dramatically increased risk of premature birth.
25. I don’t face a dramatically increased risk of maternal death

Freidenfelds can correct me if I’m wrong, but suspect she scores close to if not exactly 25 out of 25 on the pregnancy privilege scale. And, like many beneficiaries of privilege, she’s in denial about her own privileged status.

Why? Acknowledging privilege is embarrassing, especially when you view yourself as speaking from a position of moral superiority.

My primary claim is that privileged, white women imagine that the childbirth experience that they want is what less privileged women need. I’ve analogized this in the past to sending sterling silver flatware to people dying of starvation.

To the extent that Prof. Freidenfelds engages with this claim, she deliberately misrepresents it (or, perhaps, misunderstands it).

Tuteur claims that nurse-midwifery could only possibly be appealing to middle-class white women such as myself, who she believes are inordinately attached to the idea that women might value a low-intervention birth experience, and therefore, when I advocate that nurse-midwives be available to all pregnant and birthing women who want them, I am cluelessly advocating from a position of white privilege. (my emphasis)

But that’s not my argument at all. I’m not talking about what is or is not appealing. I claim that nurse-midwifery is only appropriate for low risk women.

To use my sterling silver analogy, I would never say that fine flatware could only possibly be appealing to privileged, white women. Who wouldn’t want sterling silver flatware if they had plenty of everything else in their lives? But it is worse than meaningless for people who don’t have enough food to eat. Recommending midwives (specialists in low risk pregnancy and birth) to women who suffer inordinately from high risk conditions and complications is also worse than meaningless.

Freidenfelds also misrepresents my position on the safety of nurse midwives:

Tuteur will never accept evidence that any form of midwifery is safe. She is completely committed, at least publicly, to advocating for OB-GYNs at every birth, and no evidence of nurse-midwifery’s safety will ever be enough for her. That means that, at least as long as the evidence available to me supports the safety of nurse-midwife care for low-risk women, we will have to agree to disagree about the role of nurse-midwives.

That’s a bald faced lie. I’ve written more times than I can count that I always worked with certified nurse midwives, found them to be excellent practitioners and that the scientific evidence shows that they have a great safety record for low risk women. But by definition they can’t care for the most high risk women who are disproportionately African American, suffering from pre-existing medical problems and severe pregnancy complications. For example, the leading cause of maternal death in this country is cardiac disease. What, exactly, can midwives do to prevent cardiac deaths? Absolutely nothing.

That’s not the only thing that Freidenfelds refused to address.

Specifically:

The racist, sexist origins of natural childbirth advocacy.
The biological essentialism at the heart of natural childbirth advocacy.
The remarkable elitism of the movement that has only token representation of women of color and poor women.

Freidenfelds has nothing to say. She doesn’t deny any of that since it is all true; she simply ignores it.

How about the questions I ask in my piece?

What distinguishes midwifery from obstetrics? Is it truly a difference in outlook or merely midwives clawing for market share?
Should women be reduced to their reproductive organs and does reproduction mean the same thing to every woman?
Are midwives with all women or just privileged white women?

Freidenfelds doesn’t bother to answer these questions. As I noted in my original essay:

Natural childbirth advocates are overwhelmingly Western, white, and well off. Certified nurse midwives are overwhelmingly Western, white and well off. I find it quite shocking that in a country that struggles with high black perinatal mortality and high black maternal mortality, Freidenfelds doesn’t even bother to give lip service to the many women of color, women of other nationalities, and women with pre-existing medical conditions and pregnancy complications whose have no interest in and cannot be helped in any way by the philosophy of natural childbirth.

It’s almost as if these non-privileged women do not exist.

Freidenfelds writes:

As I explained in the essay, nurse-midwifery was originally developed to serve lower-income women who could not afford physicians’ fees. Midwives continue to disproportionately serve low-income rural and inner-city women, many of whom have difficulty accessing care otherwise.

And as I explained, that’s not true. While some nurse midwives prior to 1970 cared for poor women, they represented only a few hundred providers. Since then the number of nurse midwives has grown exponentially (now approximately 12,000) and there is no evidence they disproportionately serve poor women.

According to CDC Wonder, in 2016 African American women represented 16% of births attended by doctors and 13.5% of midwife attended births. CDC Wonder does not collect income statistics but it does collected statistics on maternal education. Women with a high school degree or less represent 40% of births attended by doctors and 37% of midwife attended births. In other words, midwives are LESS likely than doctors to attend births of African American women or poor rural/inner city women.

Freidenfelds concludes:

I do not accept Tuteur’s mis-use of the critical terminology of “white privilege.” Specious arguments based on claims about white privilege are pernicious because they weaken and discredit the concept.

I understand; who wants to be accused of being a privileged white person? Certainly not a privileged white person like Freidenfelds. She ought to present actual arguments debunking my claims instead of misrepresenting them or ignoring them. The fact that Freidenfelds cannot suggests she ought to check her privilege.

Writing on The Conversation, three UK scientists make an elementary error.

Their piece is entitled Jaundice in newborns could be an evolutionary safeguard against death from sepsis.

In newborn babies, jaundice is so common as to be termed physiological. It affects around 60% of term babies and around 80% of preterm babies in the first week of their lives. Clinicians need to monitor it carefully and sometimes treat it, since it can lead to conditions like acute bilirubin encephalopathy and kernicterus that can damage the infant’s brain and cause developmental problems.

But it now looks as though this jaundice is not merely one of the pitfalls of entering the world. New research just published in Scientific Reports, in which we have been involved, suggests that it is one of the gifts of evolution. Humans may develop jaundice as newborns to protect from something even more serious: sepsis.

The elementary mistake is invoking the the naturalistic fallacy, a logical fallacy that presumes that anything that exists in nature must be good.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]How would we determine if jaundice prevents sepsis? We would look at the relatively risk of sepsis in jaundiced babies vs. non-jaundiced babies.[/pullquote]

…[W]hy have humans not evolved to overcome this temporary bilirubin problem?

Why? Because evolution through natural selection does not produce perfection. A variety of often conflicting evolutionary pressures may result in a relatively high wastage rate.

For example, in nature many babies and mothers die because the baby is too big to pass through the maternal pelvis. The evolutionary pressure on maternal pelvis size is entirely independent of the evolutionary pressure on fetal head size. If natural selection produced perfection, human beings would have evolved some way for the mother’s body to communicate with the fetus’ body to constrain its size. That has not happened because natural selection is limited in what it can accomplish; it can only produce limited results with existing genetic material.

Moreover, evolution through natural selection leads to the survival of the fittest, NOT the survival of all. The fact that a given natural process has a relatively high death rate is entirely in keeping with that principle.

There is no evidence I’m aware of that shows that neonatal jaundice is beneficial in any way to a baby, but that hasn’t stopped these investigators from fantasizing otherwise.

One night he was looking after a baby boy who had sepsis, which is where the immune system goes into overdrive to protect against infection, potentially leading to severe inflammation, organ failure and death. This baby was profoundly unwell in intensive care, suffering from inflammation and a strikingly high bilirubin count that was only just being controlled with three phototherapy lamps. Usually this kind of difficult jaundice is caused by an immune reaction between mum’s and baby’s blood groups, but not in this case.

Richard began wondering if the bilirubin was directly linked to the infection, and if it was part of the baby’s body’s attempt to clear the sepsis (in this case the baby survived). He started thinking about the problem in evolutionary terms – if jaundice can harm the baby, what benefit does it offer to balance this?

The odds are high that the bilirubin is linked to the infection but not in the way that the investigators imagine. Sepsis can injure the liver, decreasing its ability to metabolize bilirubin. Sepsis induced jaundice occurs at all ages.

According to Clinical review: The liver in sepsis:

During sepsis, the liver plays a key role. It is implicated in the host response, participating in the clearance of the infectious agents/products. Sepsis also induces liver damage through hemodynamic alterations or through direct or indirect assault on the hepatocytes or through both. Accordingly, liver dysfunction induced by sepsis is recognized as one of the components that contribute to the severity of the disease.

In other words, there is no reason to believe that neonatal jaundice is protective against sepsis and no data that shows that neonatal jaundice prevents sepsis. No matter.

The results of this project have just been published. Our team have shown that even modest concentrations of bilirubin reduced by one third the growth of Gram-positive Streptococcus agalactiae. We also showed that bilirubin may alter substrate metabolism in the bacteria.

In short, it looks like the hypothesis is bearing out. We now need to do more work, probably in animal experiments of sepsis. This will enable us to think about whether clinicians should raise the accepted bilirubin threshold for babies at risk of sepsis – those born prematurely, for example.

No, it does NOT look like the hypothesis is bearing out.

That bilirubin kills some common bacteria is not unexpected. The whole problem with jaundice in the newborn is that bilirubin is cytotoxic; if it could kill newborn brain cells, it’s hardly surprising that it can kill bacteria, too. That doesn’t mean that excess bilirubin occurs to prevent bacterial sepsis.

Sadly, this is a “just so story.”

What’s a just so story? The term comes from a Rudyard Kipling book of the same name, filled with stories like “How the leopard got its spots.” It is:

an unverifiable narrative explanation for … a biological trait … The pejorative nature of the expression is an implicit criticism that reminds the hearer of the essentially fictional and unprovable nature of such an explanation.

This story could be titled “how the infant got its jaundice.”

Kipling’s just so stories were fairytales and most contemporary efforts to use just so stories to explain evolutionary phenomena are also fairytales.

As Steven J. Gould wrote:

…unfortunately a very large part of evolutionary theory and practice, natural selection has operated like the fundamentalist’s God–he who maketh all things… When evolutionists try to explain form and behavior, they also tell just-so stories–and the agent is natural selection.

But natural selection is not the only engine of evolution.

…[W]e now reject this rigid version of natural selection and grant a major role to other evolutionary agents (genetic drift, fixation of neutral mutations, for example). We must also recognise that many features arise indirectly as developmental consequences of other features direct subject to natural selection. Moreover, and perhaps most importantly, there are a multiple of potential selective explanations for each feature. There is no such thing in nature as a self-evident and unambiguous story.

How would we determine if jaundice prevents sepsis? We would look at the relatively risk of sepsis in jaundiced babies vs. non-jaundiced babies. Unless and until we can show that jaundice is protective, we have no business asserting that it is protective. We also have no business extrapolating from test tubes to human beings. No doubt bleach also kills the bacteria that cause neonatal sepsis, but that’s not a reason to start giving sick babies bleach.

The authors conclude:

It feels like we’re discovering something new about the physiology of newborn babies. It’s the excitement of being a clinician scientist: taking an idea from a real patient into the laboratory and testing then developing it to hopefully help future patients. When newborn babies develop jaundice in future, we’ll still need to treat it carefully. But quite possibly we will also be thankful that it’s protecting them from something potentially life-threatening.

No one has discovered anything about the physiology of newborn babies because no one looked at the physiology of newborn babies. They made up a just so story.

Just so stories are remarkably attractive; that’s why scientists must be very careful not to invoke them. They should be even more cautious about advancing therapeutic recommendations based on what at the moment is little more than wishful thinking.

Bed sharing has always been dangerous. The first reported bed sharing death occurred nearly 3,000 years ago.

Two women came to King Solomon and stood before him. One woman said: “My Lord, this woman and I dwell in the same house, and I gave birth to a child while with her in the house. On the third day after I gave birth, she also gave birth. We live together; there is no outsider with us in the house; only the two of us were there. The son of this woman died during the night because she lay upon him. She arose during the night and took my son from my side while I was asleep, and lay him in her bosom, and her dead son she laid in my bosom. when I got up in the morning to nurse my son, behold, he was dead! But when I observed him (later on) in the morning, I realized that he was not my son to whom I had given birth!”

You may recognize this as the background to a story of King Solomon’s wisdom in suggesting that the two women split the baby.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Those who promote bed sharing “have never heard the guttural scream from a mother who was just told her baby was dead.”[/pullquote]

Bed sharing was a deadly problem in 950 BC and it’s a deadly problem in 2018. That’s why pediatricians and public health officials are in agreement that bed sharing with young infant should be avoided. Lactivists, however, who believe that bed sharing is critical to promoting breastfeeding, have been working very hard to conceal or minimize its risks.

They often cite Notre Dame anthropologist James McKenna who wrote the 2015 paper There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping.

McKenna coined the term “breastsleeping” in an effort to:

help both resolve the bedsharing debate and to distinguish the significant differences (and associated advantages) of the breastfeeding–bedsharing dyad when compared with the nonbreastfeeding–bedsharing situations, when the combination of breastfeeding–bedsharing is practiced in the absence of all known hazardous factors. Breastfeeding is so physiologically and behaviourally entwined and func- tionally interdependent with forms of cosleeping that we propose the use of the term breastsleeping to acknowledge the following: (i) the critical role that immediate and sustained maternal contact plays in helping to establish optimal breastfeeding; (ii) the fact that normal, human (species wide) infant sleep can only be derived from studies of breastsleeping dyads … and (iii) that breastsleeping by mother–infant pairs comprises such vastly different behavioural and physiological characteristics compared with nonbreastfeeding mothers and infants …

That’s a fancy and long winded (and unverifiable) way of implying that promoting breastfeeding is more important than whether babies lie or die.

Is it?

I belong to a private Facebook group of medical professionals who were discussing this issue. The stories that nurses told were chilling. If you think bed sharing death is something that only happens to other people, people who smoke and drink and use drugs, think again.

Consider:

Whenever I think about cosleeping it reminds me of a former patient of one of my coworkers. My friend and coworker had cared for a baby in NICU for 4 months. The first night the parents had the baby home, they decided to sleep with the baby in their bed. The baby ended up suffocating and dying that night, first night home after 4 months in NICU.

Or this:

This issue really hits home with me. For the last 2 years I have been living in xxxx, where they are proud of the fact that every maternity hospital is designated Baby Friendly. I know I have personally cared for 3 infants who died from SIDS after discharge due to co-sleeping. I have also helped futilely code a 2 month old brought into the ER in cardiac arrest. Mom admitted to co-sleeping and was EBF.

The baby was not considered high risk.

This infant would have been considered “low risk,” .., thus it would have been an acceptable risk to co-sleep. They obviously have never heard the guttural scream from a mother who was just told her baby was dead. There are not words to comfort her when she keeps asking how she is going to tell her husband who is deployed overseas.

The nurse goes on to say:

Mind you I am currently a nurse in a small 15 bed level II NICU. Formerly, I worked in a xxxx 90 bed high acuity level III NICU, which unofficially practiced Fed is Best. We would occasionally hear of some of our former graduates dying of SIDS, but nothing like the frequency I hear about in my current NICU. If one of the stated benefits of exclusive breastfeeding and a promoted benefit of Baby Friendly hospital designation is reduced SIDS rates, then why does there seem to be a real issue in a state where the only option is to deliver at a baby-friendly facility?

A third nurse writes:

I too have been involved with multiple SIDs cases. One was IN our BFHI hospital, suffocation while BF during the night–fresh section mom.

That’s not the only harm from breastfeeding promotion. As the second nurse comments:

Believe me, it has been an eye opening experience going from a feeding friendly hospital to a baby-friendly hospital. The amount of preventable infant harm I have seen is sickening. From severe dehydration to SIDS, there are so many things wrong with baby friendly practices.

The idea that co-sleeping must be closest too perfection because it’s natural is a perversion of evolutionary theory. Evolution does not lead to perfection. Many natural practices have high failure/death rates. Only the fittest survive and fitness changes as the environment changes.

Even if it were the case that women and babies co-slept in the past, they did so on bare ground in the cold. Humans haven’t slept on the bare ground in the cold since fire was mastered. The way we sleep has changed over time and now we sleep in ways that are harmful to babies: on soft surfaces and with soft bedding.

Moreover, there is nothing inherent in sleeping separately that prevents a mother from breastfeeding exclusively. Bed sharing just makes breastfeeding more convenient and therefore supposedly more likely. The underlying assumption is that breastfeeding is so critically important to infant health and that risking an infant’s death is a reasonable choice in order to promote breastfeeding. Except breastfeeding is not critically important and dead babies can’t breastfeed.

An individual mother may consider the small risk of death from bed sharing an acceptable choice. But she can’t make an informed choice if lactivists lie about the risks. Bed sharing is deadly in low risk situations as well as high risk situations. Mothers deserve to know.