One of my proudest moments as a physician occurred years after I stopped practicing.

At a holiday dinner table a cousin commented that had I faced infertility, I would have opted for adoption over complex medical treatment just as she had done. I was surprised since nothing could be further from the truth; I would have aggressively pursued every medical option.

It was her turn to be surprised since she remembered I was one of the very few doctors supported her decision to forgo infertility treatment without even trying. How, she asked, could I have kept my desires out of our discussion? Because, I answered, it is the job of a physician to support a patient’s choices, not to seek validation by having the patient make the physician’s preferred treatment choice.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It is the provider’s ethical obligation to support the patient’s goals not to substitute their own values — midwives and lactation consultants included.[/pullquote]

I believe, as matter of both medical and personal ethics, that doctors should never look to patients for validation of their own ideals. It is the doctor’s legal and medical obligation to support the patient’s goals not to substitute his or her own values.

If a Jehovah’s Witness wants to decline blood transfusions, I have no right to insist that she accept them even though I would eagerly choose them if the need arose. If a patient wants to decline a life saving C-section for her baby, I have no right to insist that she undergo surgery even though I would accept immediately. If a patients wishes to treat her cancer with herbs and supplements instead of chemotherapy, I have no right to insist that she accept chemotherapy in favor of a course of action I know to be worthless.

I suspect most doctors would agree with my views; that’s what we are taught. In contrast, midwives and lactation consultants seem to think that is their job to pressure patients to mirror the choices that midwives and lactation consultants would make. They rationalize it by telling themselves that “normal birth” and breastfeeding are best; midwives and lactation consultants therefore imagine that they have the patient’s best interests at heart but not only is that deeply paternalistic; it is entirely untrue.

As Atul Gawande Tweeted yesterday in reference to new cancer treatments:

The seriously ill have goals for their care besides just survival. When we don’t ask what they are (what tradeoffs they’d make & not make; what quality of life is unacceptable) and tune care accordingly, incl new treatments, the result is suffering.

This also applies to pregnant women. Many have goals for their care that may not include vaginal birth, refusing pain relief and avoiding interventions. Yet many midwives ignore those goals. They “know” that unmedicated vaginal birth is “best” and they force women into accepting it, going as far as creating promotional campaigns for so called normal birth.

It’s not that they don’t understand the concept of separating the patient’s interest from the provider’s interest. They have no trouble counseling women to ignore doctors’ recommendations on C-section, interventions and the advisability of homebirth, claiming that “birth rights are human rights” and often insinuating that doctors’ push interventions for their own benefit. Nonetheless, they appear entirely blind to the concept that birth rights include the right to a timely epidural as soon as a woman asks, the right to request term induction even if there is no medical reason and the right to a C-section on maternal request.

Many midwives are simply incapable of separating the patient’s interest from their interests. Their treatments recommendations for others reflect what they would choose for themselves; they need patients to mirror their preference for unmedicated vaginal birth back to them and they force them to do so. They often insist that patients who don’t agree aren’t properly informed or adequately supported.

The same midwives who would react (appropriately) with horror at a doctor forcing a C-section on a woman who has declined have no trouble forcing an unmedicated vaginal birth on a woman who doesn’t want one. That’s unethical.

Lactation professionals are, if anything, worse. La Leche League won’t even allow you to become a volunteer leader unless you have breastfed a baby for 9 months. Lactation consultants exist for the sole purpose of promoting breastfeeding; they promote a process independent of outcome even though the benefits of that process are trivial and side effects are common. It’s not for the good of babies. Breastfeeding doubles the risk of neonatal hospital readmission, increases the risk of neonatal hypernatremic dehydration and hypoglycemia and is the leading cause (90% of cases) of jaundice induced brain damage. Lactation consultants pressure women to mirror their own feeding choice back to them without regard to a mother’s personal needs, desires and priorities. That’s unethical

The bottom line is that patients don’t exist to support providers; providers exist to support patients whether or not providers approve of patients’ choices. It’s long past time for midwives and lactation consultants to recognize this.

The adulation must be truly head turning.

I can’t otherwise explain why Neel Shah, MD, who ought to be completely cognizant of both the scientific literature and the history of people he supports, is giving legitimacy to midwives with blood on their hands and self-serving nonsense in their heads.

Advocates of “normal” birth have been waiting for years for a respected obstetrician to legitimize their deadly ideology and Dr. Shah is making their dreams come true without a thought for the many mothers and babies who have suffered at their hands.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Dr. Shah is making their dreams come true without a thought for the many mothers and babies who have suffered at their hands.[/pullquote]

First we learn that Dr. Shah is taking part in the for profit venture Birthpedia a website that features advocates of pseudoscience and poor practice, including Ina May Gaskin, Michel Odent, Brad Bootstaylor, Barbara Harper and a chiropractor, among others.

Dr Gena Bofshever has an infectous personality to go along with her thorough chiropractic skills to help women who want to get pregnant by making the organs in their body easier to talk with their brain. (my emphasis)

Dr. Shah wasn’t merely one of the contributors; he featured prominently in their promotional materials:

“Imagine having a Harvard OBGYN answer your specific question/concern for only $8 a month. We are changing how providers and patients intake information about birth where any pregnant woman can get answers by qualified professionals” – Co-Founder Justine Tullier

After I wrote on my Facebook page about Dr. Shah’s association with quackery, the Birthpedia information on Dr. Shah and the other contributors disappeared from the internet. Hopefully Dr. Shah was unaware that he was associating with quacks and charlatans and reconsidered his involvement.

Several days ago, Dr. Shah tweeted his excitement at a forthcoming meeting of Sheena Byrom, a leader in UK midwifery.

Byrom is the poster child for moral depravity in the face of preventable infant deaths. She has the unmitigated gall to defend the unethical behavior of midwives in privileging process over outcome by arguing that it is more important to preserve “normal birth” than human life.

Despite dozens of preventable perinatal and maternal deaths at the hands of UK midwives, despite the fact that liability payments now account for fully 20% of UK midwifery spending, despite multiple investigations detailing poor midwifery practice and strenuous attempts to hide it by midwives lying to investigators and regulators bodies, Byrom insists on Normal birth – a moral and ethical imperative:

Yes, there needs to be learning from incidents, and development where needed. But blaming one professional group, or a particular type of birth, does little to improve any situation.

Actually, insisting that a professional group take responsibility for their own deadly mistakes does A LOT to improve any situation.

But that’s not the worst of Bryom’s behavior. She has become well known for publicly tormenting a father who lost his son in the Morecambe Bay midwifery scandal.

Now comes news that Dr. Shah is headlining Normal Birth 2018.

Of course Dr. Shah may have no idea what he’s getting into. It wouldn’t be the first time.

He certainly had no idea about homebirth when he wrote about it in the New England Journal of Medicine, A NICE Delivery — The Cross-Atlantic Divide over Treatment Intensity in Childbirth, and for a companion piece Are hospitals the safest place for healthy women to have babies? An obstetrician thinks twice on The Conversation.

Dr. Shah appeared entirely unaware of the two most important issues in American homebirth.

1. In contrast to the UK where there is only one type of midwife, highly educated and highly trained, in the US there are two types of midwives: certified nurse midwives (CNM), the best educated, best trained midwives in the world, and a second, inferior class of midwife, certified professional midwives (CPM), who lack the education and training of midwives in every other industrialized country.

2. There is a large and growing body of research that demonstrates that home birth with an American home birth midwife has a death rate 3-9 times higher than comparable risk hospital birth.

Dr. Shah is one of the plenary speakers at Normal Birth 2018. Others include Melissa Cheyney, anthropology professor and homebirth midwife and Soo Down, midwifery professor and promoter of goofy, quack midwifery theory.

Does Dr. Shah know that Melissa Cheyney has single-handedly done more to hide the growing toll of tiny bodies of babies who succumb to American homebirth than anyone else? She has lied, denied, decried and defied efforts to inform the public of the hideous death toll at homebirth.

Does he care that Cheyney, in her role as the Chair of the Oregon Board of Direct Entry Midwifery, steadfastly REFUSED to release the homebirth mortality rates in her possession for fear that regulatory authorities might wish to investigate the death rate and discipline the midwives involved in the deaths. In the face of that refusal state of Oregon subsequently hired Judith Rooks, CNM, MPH, a known supporter of homebirth, to calculate the Oregon homebirth death rate in 2012. Rooks found that the death rate at the hands of LICENSED homebirth midwives was 800% higher than comparable risk hospital birth.

Is Dr. Shah aware of Soo Downe’s midwifery “philosophy”? Downe, like many quacks, won’t accept the existing scientific evidence and invokes quantum mechanics, a concept she knows nothing about, to rationalize her refusal to accept copious evidence on the dangers of promoting “normal” birth.

The implication of the new subatomic physics was that certainty was replaced by probability, or the notion of tendencies rather than absolutes: ‘we can never predict an atomic event with certainty; we can only predict the likelihood of its happening’… This directly contradicts the mechanistic model we explored above, and it implies that a subject such as normal birth needs to be looked at as a whole rather than its parts…”

Prof. Downe has managed a stupidity trifecta: she used the wrong theory, from the wrong field, wrongly interpreted to reach the ideologically predetermined result.

Dr. Shah, these women are not your friends. More importantly, they are not the friends of babies and mothers, too many of whom have died at their hands or as a result of their beliefs.

Do you really want to legimitize midwives with blood on their hands?

Are you a paleo-sucker?

Paleo-suckers believe in the central conceit of modern alternative health that human beings reached the acme of our existence during the Paleolithic Era. According to advocates of “natural living,” our bodies were designed for the demands of life in the Paleolithic and technology, whether modern diets, modern medicine or modern parenting, is making us sick; and returning to the Paleolithic lifestyle will make us healthy.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Paleo-suckers are longing for a past that literally never existed anywhere except in their dreams.[/pullquote]

Nothing could be further from the truth. The dirty little secret about our Paleolithic ancestors is that they were relatively poorly designed from an evolutionary perspective. Indeed, we came very close to extinction during that era and our closest hominid relatives, the Neanderthals, did become extinct. The fact that we are still here has nothing to do with our biology and everything to do with technology.

So where did some people get the idea that life in nature was wonderful?

William Buckner explains in Romanticizing the Hunter-Gatherer:

In 1966, at the ‘Man the Hunter’ symposium held at the University of Chicago, anthropologist Richard B. Lee presented a paper that would radically rewrite how academics and the public at large interpret life in hunter-gatherer societies. Questioning the notion that the hunter-gatherer way of life is a “precarious and arduous struggle for existence,” Lee instead described a society of relative comfort and abundance. Lee studied the !Kung of the Dobe area in the Kalahari Desert (also known variously as Bushmen, the San people, or the Ju/’hoansi) and noted that they required only 12 to 19 hours a week to collect all the food they needed. Lee further criticized the notion that hunter-gatherers have a low life expectancy, arguing that the proportion of individuals older than 60 among the !Kung, “compares favorably to the percentage of elderly in industrialized populations.” On the basis of Lee’s work, and other material presented at the symposium, anthropologist Marshall Sahlins coined the phrase “original affluent society” to describe the hunter-gatherer way of life.

It is difficult to overestimate the impact of this idea.

It’s not often that you see a 50-year-old paper repeatedly referenced in mainstream publications, but you can find mentions of Lee’s work pretty much everywhere today. In the Guardian, the New York Times, the London Review of Books, the Financial Times, and Salon, among others. Much of this attention has to do with two recently published books, Against the Grain by James C. Scott and Affluence without Abundance by James Suzman, both of which are informed by Lee and Sahlins’s conception of hunter-gatherer affluence. An article in the September 18 [2017] issue of the New Yorker by John Lanchester heavily cites each of these books in order to make “The Case Against Civilization.”

There is just one problem. The claims in the paper were not true.

As Lee himself would later mention in his 1984 book on the Dobe !Kung, his original estimate of 12-19 hours worked per week did not include food processing, tool making, or general housework, and when such activities were included he estimated that the !Kung worked about 40-44 hours per week.

That still sounds pretty good in exchange for a life of abundance.

But:

[I]t is important to note that this does not take into account the difficulty or danger involved in the types of tasks undertaken by hunter-gatherers. It is when you look into the data on mortality rates, and dig through diverse ethnographic accounts, that you realize how badly mistaken claims about an “original affluent society” really are.

Though hunter-gathers purportedly “work” less time to get their food, they are much more likely to die doing so.

Moreover, Lee’s claims are belied by actual mortality data:

In his later work, Lee would acknowledge that, “Historically, the Ju/’hoansi have had a high infant mortality rate…” In a study on the life histories of the !Kung Nancy Howell found that the number of infants who died before the age of 1 was roughly 20 percent. (As high as this number is, it compares favorably with estimates from some other hunter-gatherer societies, such as among the Casiguran Agta of the Phillipines, where the rate is 34 percent.)

In other words, the death rate from natural mothering — the holy grail for contemporary advocates of “normal” birth and breastfeeding — was astronomical.

And although there may be individuals over 60 in these populations:

Life expectancy for the !Kung is 36 years of age. Again, while this number is only about half the average life expectancy found among contemporary nation states, this number still compares favorably with several other hunter-gatherer populations, such as the Hiwi (27 years) and the Agta (21 years)…

Who would want to emulate that?

But aren’t hunter-gathers better protected against infectious diseases that occur when large numbers of people live close together?

Much is made of the increased risk of infectious disease in large, concentrated, sedentary populations, but comparatively little attention has been given to the risk of ‘traveler’s diarrhea’ common among hunter-gatherers. For mobile groups, infants, the elderly, and other vulnerable individuals have little opportunity to develop resistance to local pathogens. This may help explain why infant and child mortality among hunter-gatherers tends to be so high. Across hunter-gatherer societies, only about 57% of children born survive to the age of 15. Sedentary populations of forager-horticulturalists, and acculturated hunter-gatherers, have a greater number of children surviving into adulthood, with 64% and 67%, respectively, surviving to the age of 15.

Why have people clung to the original claim about the “abundance” of hunter-gatherer society despite the fact that they have been debunked again and again? Why do people allow themselves to become paleo-suckered?

In wealthy, industrialized populations oriented around consumerism and occupational status, the idea that there are people out there living free of greed, in natural equality and harmony, provides an attractive alternative way of life. To quote anthropologist David Kaplan, “The original affluent society thesis then may be as much a commentary on our own society as it is a depiction of the life of hunter-gatherers. And that may be its powerful draw and lasting appeal.”

Paleo-suckers from Gwyneth Paltrow to the Food Babe Army, from anti-vaxxers to lactivists and natural childbirth advocates are longing for a past that literally never existed anywhere except in their dreams.

There would be nothing wrong with that if the only thing injured as a result were people’s wallets. Sadly, attempting to recapitulate a natural Eden that never existed injures people, keeps them from getting appropriate healthcare and can even lead to death.

Imagine that a woman in the midst of a miscarriage, bleeding heavily, arrived at her local emergency room for treatment. The pregnancy could not be saved. Indeed, while waiting for medical attention the mother passed the products of conception in their entirety and the bleeding stopped. The tissue would ordinarily be treated as medical waste, incinerated and sent to a sanitary landfill. Of course, if she chose, the mother could arrange for a private burial.

However, this local hospital is an Islamic hospital, and operates on the principles of Sharia Law. The mother is informed that the tissue will be buried in an Islamic cemetery with a burial service conducted by an imam. If she did not want an Islamic burial, she could pay for a private burial at her expense.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Why is it acceptable to allow Catholic hospitals to impose Catholic doctrine on non-Catholics?[/pullquote]

The outrage of political conservatives would know no bounds. Despite zero evidence, many already fear that Muslim Americans wish to impose Sharia Law on non-Muslims. A hospital operating under Sharia Law would confirm their fears. It hasn’t happened yet simply because there are no Muslim hospitals in the US. But conservatives would be absolutely correct in opposing a hospital’s imposition of Muslim Law on non-Muslims as a violation of religious freedom.

So why do they find it completely acceptable to allow Catholic hospitals to impose Catholic doctrine on non-Catholics?

According to Sophie Novack of The Texas Observer:

A Catholic hospital in Austin forces patients who miscarry to consent to fetal burials. For one woman, that made a painful loss even worse …

Quietly, for more than 10 years, Seton has required the burial of all fetal remains after miscarriages. It’s widely known that Seton, which follows the ethical and religious directives of the Catholic Church, doesn’t perform abortions or offer contraceptives. But its policy on miscarriages is a secret even to some nurses and doctors who work at the hospital. Seton declined to give the Observer a copy of the policy, but a doctor who practices at the hospital provided one. “As a catholic institution, the Seton Healthcare Family policy is for all loss of life to be given a proper burial,” it reads.

Novack tells the story of Blake Norton who was scheduled to have a “missed miscarriage” (a pregnancy that has died) removed at Seton Hospital.

She calls what followed a “hazy nightmare.” Overwhelmed with grief, Norton waited in the lobby for hours and filled out paperwork. Finally, a nurse guided her into an exam room to change, and put an IV in her arm. She was about to be wheeled into surgery when she was handed one last form to sign. Confused, Norton scanned the document, quickly realizing that she was being asked to consent to the burial of the fetal remains. She could choose between two options: Seton would bury the remains in a shared grave, or Norton could arrange for a “private burial” at her own expense.

But she didn’t want the tissue to be buried in a Catholic religious ceremony.

Could she opt out of having a burial? Norton asked. The nurse shook her head, and sent a social worker to speak with her. “I don’t understand, why do I not have a choice?” Norton asked, increasingly upset. What had been a medical procedure suddenly felt like a religious rite, compounding the grief she was only beginning to process. The social worker reiterated that she could choose between the two burial options. Norton elected to leave it to Seton and opted not to be notified when the burial occurred. Where the form required her to specify her relationship to the remains, Norton said she had no choice but to write “mother.”

What does that burial look like? The reporter sought to find out:

A man, an employee of the cemetery, guides me on a golf cart to a row of flat headstones and points to one marking the group grave where the remains of Norton’s pregnancy are buried. “You are our sunshine, our only sunshine,” the headstone reads, below a date — August 12, 2015, nearly two months after Norton’s miscarriage. An image of the Virgin Mary is etched into the stone.

Surely this should be a violation of Texas law since it infringes on Blake Norton’s religious freedom, but it’s not.

In 2017, Republican state lawmakers passed a controversial law mandating the burial or cremation of all fetal remains of less than 20 weeks gestation after abortions and miscarriages that occur at medical facilities. (The state already required burial or cremation of fetal remains over 20 weeks.)

The Texas legislators almost certainly assume that the hospital will conduct the burials under Judeo-Christian principles. Would they be so eager to mandate burials if they were being done according to Sharia Law? I doubt it. They would almost certainly consider being subjected to Sharia Law as a violation of their religious freedom and they would be right.

And that suggests that laws mandating burial of tissue from miscarriages have nothing to do with freedom of religion of hospitals and everything to do with imposing approved religion on non-believers. That may be consistent with Christian doctrine of proselytization but it’s incompatible with the American principle of religious freedom.

Who lets her toddler get whooping cough and then boasts about how she breastfed him though it? A self-absorbed, self aggrandizing narcissistic parent. Someone like Shayla Cherry.

It’s difficult for me to describe the cruelty, stupidity and lack of self-awareness of a mother like Cherry so I’ll let her describe it herself.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The true sign of Shayla Cherry’s narcissism is that she is boasting about the horror that she caused.[/pullquote]

From How Breastfeeding Saw Us Through the 100-Day Cough:

Rye was 18 months old when he contracted pertussis. I can’t begin to imagine how terrifying that would have been if, like nine out of ten babies, he was weaned already…

How terrifying it would have been? It wouldn’t have been terrifying at all if her child had been fully vaccinated because he wouldn’t have gotten whooping cough. But Shayla had “done her research” and is proud of herself for depriving him of that protection.

From The Risks of Routine Vaccination: Why I Don’t Vaccinate My Son:

I discovered that the diseases are less likely to harm my son than the vaccines themselves. Adverse reactions and chronic illnesses are far more common than serious complications from the diseases we vaccinate against.

There is nearly zero risk of an American child catching diphtheria or polio.

Despite all of the fear-mongering around polio, it’s generally asymptomatic. When symptoms do appear, they are usually flu like. Fewer than one percent of people who contract polio experience paralysis.

Whooping cough can be treated with Vitamin C…

Cherry is sublimely confident in her ignorance.

As it was, our bout with whooping cough was brutal, but never dangerous…

The truth is dramatically different.

As the CDC notes:

Before pertussis vaccines became widely available in the 1940s, about 200,000 children got sick with it each year in the United States and about 9,000 died as a result of the infection. Now we see about 10,000 to 40,000 cases reported each year and unfortunately up to 20 deaths.

Whooping cough is not merely dangerous; it’s deadly.

Fortunately, Cherry’s son did not die but he suffered tremendously and unnecessarily.

One week in and my son’s cough was only getting worse. We were up all night as he began coughing every hour, on the hour. He developed a sharp, desperate inhale; a characteristic whoop every mother hopes to never hear. I began researching pertussis with a sinking heart. Little did I know, we were in for a long and exhausting winter.

The next month was spent indoors as whooping cough tore through our home. Our days were filled with movies, cuddled together in our cozy haze. Sometimes when the coughing woke him at night, he was so exhausted that he’d fall back to sleep without nursing…

On our bed propped on an incline, we slept in fifty-minute bursts. We welcomed play at 2am in the dim hallway light when a coughing fit left him wide awake.

The child was desperately and needlessly sick for months and his mother is still focused on herself and the “benefits” she provided him by breastfeeding:

He would have lost every ounce of baby fat. We may have needed to go to urgent care for an IV, and who knows where that would have led — secondary infection, pneumonia, antibiotics…

There’s no reason to believe that breastfeeding did any of that. The baby could have just as easily bottle fed for comfort and nutrition. Breastfeeding didn’t prevent whooping cough in the first place; why should it be counted on in preventing secondary infection?

Cherry’s narcissism hasn’t merely blinded her to the fact that she subjected her toddler to a potentially deadly illness because her ego led her to imagine that she knew more about vaccines than nearly every single medical professional in the entire world.

Her narcissism hasn’t merely made her oblivious to the fact she is the one responsible for son’s suffering, not the one who prevented it.

The true sign of her overweening sense of self regard is that she is boasting about the horror that she caused.

Though I was more tired than I’ve ever been and my own health hasn’t quite recovered, I am immeasurably grateful for the gift of breastmilk. I was able to nourish and protect my son, even in the depths of my exhaustion. So, if you’re nursing a toddler and want to continue, I hope sharing my story helps you to trust your instincts. Do what is right for you and your child, as mothers have done for aeons.

Cherry learned nothing … but then narcissists never do.

A piece that will appear in The New York Times Sunday Magazine attempts to answer the question Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis. Unfortunately, the answer it gives — that black women’s health is uniquely “weathered” by racism — while intuitively appealing, is probably wrong.

The tl;dr answer can be summarized as follows:

While racism is hardly limited to African Americans (think Native Americans nearly wiped out in a de facto genocide) the high rates of maternal and neonatal mortality are nearly exclusive to those of African descent.

And though the attention to the tremendous discrepancy in black vs white mortality rates has focused on the US, the problem is the same or worse for women of African descent in other countries.

Let’s look closer at the NYTimes piece and the existing research.

Linda Villarosa clearly lays out the problem:

Black infants in America are now more than twice as likely to die as white infants — 11.3 per 1,000 black babies, compared with 4.9 per 1,000 white babies, according to the most recent government data — a racial disparity that is actually wider than in 1850, 15 years before the end of slavery, when most black women were considered chattel. In one year, that racial gap adds up to more than 4,000 lost black babies. Education and income offer little protection. In fact, a black woman with an advanced degree is more likely to lose her baby than a white woman with less than an eighth-grade education.

This tragedy of black infant mortality is intimately intertwined with another tragedy: a crisis of death and near death in black mothers themselves. The United States is one of only 13 countries in the world where the rate of maternal mortality — the death of a woman related to pregnancy or childbirth up to a year after the end of pregnancy — is now worse than it was 25 years ago. Each year, an estimated 700 to 900 maternal deaths occur in the United States. In addition, the C.D.C. reports more than 50,000 potentially preventable near-deaths, like Landrum’s, per year — a number that rose nearly 200 percent from 1993 to 2014, the last year for which statistics are available. Black women are three to four times as likely to die from pregnancy-related causes than their white counterparts, according to the C.D.C. — a disproportionate rate that is higher than that of Mexico, where nearly half the population lives in poverty — and as with infants, the high numbers for black women drive the national numbers.

What explains the disparity? The causes could be genetic, environmental or both. Villarosa favors an environmental explanation.

Dr. Arline Geronimus, a professor in the department of health behavior and health education at the University of Michigan School of Public Health, first linked stress and black infant mortality with her theory of “weathering.” She believed that a kind of toxic stress triggered the premature deterioration of the bodies of African-American women as a consequence of repeated exposure to a climate of discrimination and insults. The weathering of the mother’s body, she theorized, could lead to poor pregnancy outcomes, including the death of her infant.

That’s an extraordinary claim and it falls apart fairly quickly when extended beyond black women.

If “weathering” were an accurate explanation of the black/white disparity in mortality, we would expect to find evidence of it in other populations exposed to racism. But that’s not what we find at all.

This graph comes from the 2017 paper Pregnancy-Related Mortality in the United States, 2011–2013.

As you can see, black maternal mortality dramatically exceeds white maternal mortality. But if the weathering theory were true, we would expect that other ethnic groups would also experience weathering and that’s not what happens. One might argue that discrimination against African Americans is worse than discrimination against other ethnic groups but it’s simply not possible to argue that there is no discrimination against Hispanics. Nevertheless, maternal mortality statistics for Hispanic women are better than those of anyone else including white women.

The mortality discrepancy extends to other countries, too. The UK Confidential Enquiries into Maternal Deaths and Morbidity 2013–15 shows that maternal deaths of black women is 4X higher in the UK; that’s a greater discrepancy than the US.

The situation is similar for perinatal mortality:

One of the strongest pieces of evidence in favor of the weathering theory is that black pregnancy outcomes get far worse as women get older. According to the theory, the effect of discrimination and insults is cumulative. Therefore, the disparity gets greater as women get older. If that were the case, though, we should see widening disparities in deaths rates as women get older and that’s not what we find. The disparity actually decreases as women get older.

White women born in 2015 are expected to live for 81.1 years, Hispanic women for 3.2 years more and black women for 3 years less. In contrast, among women who turned 65 in 2015, white women had a further life expectancy of 20.5 years, Hispanic women an additional 2.2 years more and black women only 0.9 years less. Similarly, for women who turned 75 in 2015, white women had an additional life expectancy of 12.9 years, Hispanic women an additional 1.8 years more and black women only 0.2 years less.

Obviously the best way to test the weathering hypothesis would be to look at maternal and neonatal mortality rates in countries where black people make up the majority of the population and are governed by other black people. Such countries are in sub-Saharan Africa and they have the worst maternal and perinatal mortality rates in the world as illustrated by this map of maternal mortality from the WHO.

There are a myriad of factors that result in high maternal and perinatal mortality in Africa so it’s impossible to blame race. Nonetheless, it means that if race is a specific risk factor for genetic reasons, it is hidden behind the socio-economic problems of the continent.

Racial discrimination undoubtedly plays a role in high rates of maternal and infant mortality but there are other groups that face considerable racial discrimination and they don’t have comparably poor mortality rates. Moreover, women of African descent have higher mortality rates regardless of where they live; indeed, the driver of maternal and perinatal mortality rates in industrialized countries is the percentage of women of African descent in the population.

Although Villarosa, the author of the NYTimes piece, implies that genetic factors have been ruled out, that’s hardly the case. Scientists and physicians are loath to invoke genetics when it comes to racial differences and there are good reasons to be wary. Nonethess, we know that there are certain genetic mutations that conferred benefit on African populations (like the mutation for sickle cell anemia that was protective against endemic malaria) that now, in the absence of malaria, only confer harm. It would be a tragedy if we failed to look for such explanations for high black maternal and perinatal mortality and fell back on environmental explanations that are more intuitively appealing but could very well be wrong.

Lactivists are confused.

We need to learn what nerve fed is best has touched and work out what that is.

I’m not sure why they’re scratching their heads over three simple words that mean what they say: breastfeeding may be (slightly) better than formula, but fully fed is best.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]In every article, meme and Facebook comment insisting that breast is best, replace the word “breast” with “heterosexuality.” See how ugly it sounds?[/pullquote]

But since they’re still confused I think a thought experiment might help. In every article, meme and Facebook comment insisting that breast is best, replace the word “breast” with “heterosexuality.”

I found the perfect example for this thought experiment in a comment on The Milk Meg’s post supporting the vile Stefania Giraldi piece I wrote about earlier this week.

Brittney has this to say:

The current attitude of the “fed is best” crowd has made me hostile towards them.

It’s not that I think formula is actually the devil, or that there are no moms who couldn’t, or that there’s actually something wrong with simply not wanting to.

The issues I’ve seen are clear:

1. They do not want mothers to celebrate their breastfeeding journey.

2. They sabotage mothers who clearly state they want to breastfeed.

3. They are anti science and argue with facts that do not fit their agenda. (Like WHO recommendations.)

4. Some “Fed Is Best” ladies are not just pro formula. They’re anti breastfeeding. They exploit old stories for their agenda.

5. Formula feeding is not a personal accomplishment like breastfeeding is.

Formula feeding is simply buying a product from a dominant industry. There’s very little trial & error. There’s no skill to learn.

It’s like buying a store bought cake vs a made from scratch cake then telling the person who put in the effort to make the cake that the store bought one is just as good or better. It’s rude. One is a truly personal accomplishment, the other is just normal. Both cakes are usually good though.

You dont need a support group for formula feeding. We don’t need formula feeding advocacy. Women are not kicked out of establishments for formula feeding. They dont need employee protection to work and formula feed.

These advocates for formula are not making an accurate comparison. They’re just retaliating because they want to feel that their choice is superior when its not.

Let’s try the thought experiment.

They do not want women to celebrate their heterosexuality.

See how ugly that sounds?

It’s because we understand that when someone purports to celebrate their heterosexuality, it is meant to at the expense of people who are gay.

Why would you need to celebrate your heterosexuality anyway? It’s a biological function, not an achievement. The fact that you choose to act on the way that you are born is hardly remarkable.

And why would celebration be seen as integral to heterosexuality? Is someone trying to take it away from you or are gay people merely fighting for the respect every human being deserves?

Similarly is anyone trying to end celebration of breastfeeding or are women who can’t or don’t wish to breastfeed merely trying to stop celebration at their expense?

They sabotage women who clearly state they want to be heterosexual.

When you make the substitution this claim also sounds very ugly and rather nonsensical.

Is that even possible? Can you sabotage another woman’s sexuality merely by mentioning the possibility that she might be gay?

The central claim of lactivists — that every woman would breastfeed if she had enough support — is starkly reminiscent of the ugly claims of those who promote so called “gay conversion therapy.” No amount of “support” will turn someone who is gay into a heterosexual and no amount of “support” will turn a woman who can’t or doesn’t want to breastfeed into someone who can or wishes to do so.

Moreover, just as gay conversion therapy is a euphemism for hectoring, berating and bullying gay people into denying reality, breastfeeding “support” is a euphemism for hectoring, berating and bullying women into breastfeeding whether they want to or not.

They are anti science and argue with facts that do not fit their agenda.

Let’s leave aside for the moment that it is lactivists who are ignoring the large and growing body of literature on the risks and costs of promoting breastfeeding and consider another aspect of this claim:

There’s no question that heterosexuality is the biological norm, and there is no question that gay people face discrimination and even violence for openly acknowledging their sexuality. Arguably, gay people face an existence far riskier than straight people. Those are facts, yet those facts don’t justify treating gay people as second class citizens, do they? Indeed, it is no one else’s business who a gay person loves just like it is no one else’s business whether or not a woman chooses to breastfeed.

Some women are not just pro homosexuality. They’re anti heterosexuality. They exploit old stories of gay women harmed by intolerance of their families and communities for their agenda.

How idiotic does that sound? Gay people aren’t opposed to straight people; indeed straight people have nothing to do with the fact that a person is gay. Gay people don’t need to affirm their sexuality by insisting that you have the same sexuality; apparently only heterosexuals need to do that. Gay people who tell stories about the pain of intolerance do so because they don’t want anyone to endure the suffering they have endured, not to scare straight people into becoming gay.

Similarly, Fed Is Best advocates aren’t opposed to breastfeeding; many like me found that breastfeeding was the best choice for ourselves and our babies. We tell stories (and quote scientific evidence) about the harms babies suffer as the result of aggressive breastfeeding promotion into order to ensure that no other babies have to endure similar suffering.

Homosexuality is not a personal accomplishment like heterosexuality is.

The truth is that neither is a personal accomplishment any more than digesting food or breathing air is an accomplishment.

Similarly, breastfeeding is not a personal accomplishment. Up until 150 years ago every mother who ever lived did it and many of their babies died in the attempt. How can doing something that literally every other women in the world could do — give their babies nothing besides the breast — possibly be an accomplishment of any kind? It can’t.

Sure, you are free to pretend that breastfeeding is some sort of accomplishment, but don’t expect the rest of the world to share your self-serving value system.

Brittney says:

[Formula feeding is] like buying a store bought cake vs a made from scratch cake then telling the person who put in the effort to make the cake that the store bought one is just as good or better.

And insisting that breast is best is like telling a woman without an oven that the raw ingredients of a cake made from scratch cake are better for her children than a store bought cake. It’s like insisting that unless she is forcing those raw eggs, uncooked flour and 70-proof vanilla down her screaming children’s throats, she is depriving them of the “benefits” of cake made from scratch. It’s false; it’s cruel; and it’s dangerous!

Another commentor disagrees with her, but Brittney is ready with her retort:

Breastmilk a personal accomplishment. Formula feeding is a consumer choice for the privileged.

Anyone who cant follow the instructions on the can is incompetent.

People like me dont coddle grown women who are begging for validation at the expense of breastfeeding advocacy.

You’re bringing other arguments into the equation because without including medical necessity or mixed feeding you’d have no base.

Fuck Fed Is Best.

No, Brittney, fuck you and the lactivists who think like you.

Justine van der Leun’s recent piece in The Guardian has received a fair amount of attention in the childbirth community. It’s  ‘I felt I was being punished for pushing back’: pregnancy and #MeToo and subtitled ‘Pregnant women are still being patronised, blamed for our bodies’ failings, and made to feel guilty about our choices.’

Van der Leun experienced a very complicated pregnancy a few years ago:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Why have midwives replaced the factual ‘vaginal birth’ with “normal birth’ and replaced the factual ‘pain relief’ with ‘intervention’? [/pullquote]

I spent one third of 2015 – about 120 days – on bed rest. I moved only to visit a hospital or doctor’s office, where I was scrutinised and presented with a list of concrete and potential deficiencies. There was certainly something wrong with my cervix, likely something wrong with my hormone levels, probably something wrong with my placenta, and possibly something wrong with my baby’s heart. Every time I was examined – which was constantly – a new potential problem surfaced. Having already lost two pregnancies, I was overcome by the looming possibility of catastrophe. I refused to prepare for anything more than a week in advance, as if hope were interchangeable with hubris and therefore deserving of punishment.

The outcome was a healthy baby girl:

That panic ended two years ago, replaced by the more welcome panic of how to care for a baby. After so much dread, not a single could-go-wrong went wrong. I will never know if the precautions helped, or if everything was fine all along. My daughter, born healthy at full term …

Now Van der Leun is pregnant again and this is also a high risk pregnancy. But this time she is whining:

At my 20-week check, the ultrasound technician informed me that, while my baby was in perfect condition, my cervix – the portion of the uterus that stands between the baby and the world – was shortening prematurely, the condition that had caused me much grief two years earlier. The official diagnosis is “incompetent cervix”. In a “competent” female body, the cervix stays long and closed until full term, and then dilates. But in an “incompetent” female body, the buffoonish cervix can shorten and open early, allowing a baby to tumble out. The “incompetent cervix” joins a number of curious obstetric diagnoses: the “inhospitable uterus”, “hostile uterus”, “hostile cervical mucus”, “blighted ovum”. Meanwhile, men experience “premature ejaculation” and not “inadequate testicles”; “erectile dysfunction”, but never a “futile penis”. They exhibit problems, but their anatomy is not defined as lacking. Pregnant women over 35 are of “advanced maternal age”, just a slight improvement over the previous term, only recently defunct: “elderly”. Those who have suffered more than two miscarriages are known as “habitual aborters”. We experience “spontaneous abortions”. A bad habit, that impetuous self-aborting: if only we had the self‑control to stop.

Oh, grow up! It’s hard to imagine anything more immature than facing a life and death situation and whining about the language that doctors used to describe it. Van der Leun seems to believe that this both patronizing and misogynistic:

The expectations placed upon women by the obstetric establishment – especially if our pregnancies don’t follow a perfect course, and often even when they do – are presented as normal. The field of obstetrics requires women to enter into an absurd realm, or perhaps to simply remain within the absurd realm in which we already exist. We’re subjected to methods that verge on Victorian: to remain prone, and in extreme cases tilted on a hospital bed at an angle for months at a time; to forgo work, pleasure, money; to allow painful interventions and invasive procedures; to agree to major abdominal surgery. We’re told it’s for baby’s sake; anything other than blind acceptance is selfish at best, murderous at worst.

I take that back, it’s even more immature to be so self-absorbed with pregnancy as to forget about the many non-pregnant people who struggle with kidney failure, heart failure, liver failure, and other failures of vital organs such as the pancreas in diabetes. No doubt they’d trade a lifetime of death defying struggles — dialysis, insulin, transplant surgery or heart surgery — for a few months of lying in a hospital bed forgoing work, pleasure and money and ending up cured. Sadly for them, their struggles are often permanent, lasting until an early death.

Where did Van der Leun get the idea that pregnant women are uniquely patronized by medical language? From midwives, of course:

Decades ago, a group of midwives, frustrated that pregnancy was treated as a condition and women as incapable children, created an empowering birth ideology, encouraging women to be confident about their bodies’ life-giving abilities…

Van der Leun doesn’t stop to ask herself why it was providers of care who insisted that the existing language was patronizing, and why it was these same providers whose concern for patronizing language did not extend to non pregnant women; they weren’t equally upset about devastating language like premature ovarian failure. If she had, she might have concluded that complaints about language were midwifery marketing tools, crafted to claw back patients from obstetricians, not to improve patient care.

Had Van der Leun really thought about it, she might have wondered why those same midwives proceeded to exchange purportedly patrionizing obstetric language for equally patronizing midwifery language like replacing the factual ‘vaginal birth’ with “normal birth’, or replacing the factual ‘pain relief’ with ‘intervention’. She might have realized that while obstetricians used what she considered objectionable language to promote the best possible outcome for mother and baby, midwives deploy patronizing language to leverage guilt and shame in an effort to increase their employment prospects.

In the ultimate irony, Van der Leun resorted to patronizing, misogynistic claims about female obstetricians, dismissing them with:

Women now make up more than half of obstetrician-gynaecologists, but the field was designed and dominated by men for centuries.

Architecture was designed and dominated by men for centuries but no one accuses female architects of knuckling under to men when they employ the exact same principles of structural engineering. The ministry was designed and dominated by men for centuries but no one implies female ministers are knuckling under to men when they preach about the exact same God. So why should female obstetricians be cavalierly dismissed as incapable of making their own decisions? Because there is no equivalent in those professionals to midwives who want their clientele for themselves.

Is the language of medicine patronizing?

I suppose it is if you think your self-worth resides in your organs. Fortunately, no one thinks their self-worth should be based on the function of their kidneys, liver or even their heart, yet women like Van der Leun think it ought to reside in their uterus and vagina.

That’s misogyny not on the part of doctors, but on the part of midwives and others like Van der Leun who reduce women to the function of their reproductive organs.

According to scientist and author David Brin:

[S]elf-righteousness can also be heady, seductive, and even … well … addictive. Any truly honest person will admit that the state feels good. The pleasure of knowing, with subjective certainty, that you are right and your opponents are deeply, despicably wrong. Or, that your method of helping others is so purely motivated and correct that all criticism can be dismissed with a shrug, along with any contradicting evidence.

Sanctimony, or a sense of righteous outrage, can feel so intense and delicious that many people actively seek to return to it, again and again. (emphasis in original)

Lactivists are indignant. But then when are they not indignant?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]”Righteous outrage can feel so intense and delicious that many people actively seek to return to it”[/pullquote]

They’re indignant about breastfeeding rates.

A Swansea University academic has said that breastfeeding levels in the UK are the lowest in the world. She is placing much of the blame on the social pressures and attitudes that many women face and is calling for greater support for new mothers to start and continue breastfeeding.

Dr Amy Brown of the Department of Public Health, Policy and Social Sciences discusses this in her forthcoming book, Breastfeeding Uncovered. She says that breastfeeding has a whole host of benefits, including protecting the health of mothers and babies. Increasing breastfeeding rates would therefore save the UK millions of pounds each year.

It’s hard to see how breastfeeding will save any money since there is NO correlation between breastfeeding rates and healthcare costs. Indeed the UK — where lactivists are indignant about the breastfeeding rate — has one of the lowest rates of infant mortality in the world.

They’re indignant about formula. Oops! I mean artificial baby milk.

They’re indignant when anyone dares suggest that breastfeeding has risks as well benefits.

Melissa Bartick is an assistant professor of medicine at Cambridge Health Alliance and Harvard Medical School who volunteers to help hospitals become designated as baby-friendly. She called it “ridiculous” to draw the conclusion that there’s a link between newborn deaths and skin-to-skin care.

She noted that since 40% of the deaths in the first six days of life were in premature babies, there could have been other health complications. She also said there could have been other factors the study didn’t examine, like smoking or drug use by the mothers.

But most of all, they’re indignant that anyone dares criticize their self-righteousness.

In a piece surely destined to become a classic of the genre, Dear formula-feeding mothers – why are you so angry?, pathologically clueless Stefania Giraldi writes:

Those who give artificial milk feel equally attacked by those who constantly tell them how important and amazing breast milk is.’

Stefania goes on to say that, as a breastfeeding mother herself, she has been wondering why mums ‘who have not nursed their babies feel offended when they hear or read about breastfeeding’.

‘I am aware that this post of mine will unleash a tussle of no small amount but I truly want to understand what happens in the mothers who experience such negative feelings,’ she writes.

You can’t make this stuff up!

Giraldi has no interest in understanding anything. She just wants to bathe in those delicious feeling of self-righteousness.

So I ask myself: What happens to mothers who have not nursed their babies? Why do you feel so guilty? Why do you always feel like your feeding choices are called in question? Why are you offended? And why are you so angry against nursing mothers? Against us.

‘My intent is not, I repeat, to offend or hurt the mothers who have not nursed.

‘Whether you believe it or not, I despise judgment in any shape of form, I believe in support rather than war. What is this battle really about?

Stefania is indignant because she’s so misunderstood.

Perhaps I can help her understand with these gentle words:

Hey, stupid cow! Is your life so pathetic and your self esteem so low that you actually imagine you are “special” because you shove your saggy boob into your 3 year olds’ mouth every day?

Wait, what? Why are you so offended? You can be sure I don’t intend to hurt you because I despise judgment in any shape or form.

Stefania blathers on:

And I wonder why if I, or any one else writes that artificial milk is deficient compared to the maternal one (FACT), we are being crucified by those who accuse us of offending and insulting formula feeding mothers?

‘Basically, as soon as anyone talks about breastfeeding, here comes the army of those who wrongly translate every word you say into a threat, an offense towards those who did not breastfeed.

Here’s a thought, Stefania: maybe no one is offended that you breastfeed; they’re offended by your self-righteousness.

Ask yourself, Stefania, is it pleasureable to know with certainty, that you are right and your those lazy morons who formula feed are deeply, despicably wrong? Do you feel proud that that your method of helping others is so purely motivated and correct that all criticism can be dismissed with a shrug?

Because the truth is that this has nothing to do with breastfeeding and everything to do with the lactivist addiction to self-righteousness. It doesn’t matter to lactivists that the benefits of breastfeeding are trivial. It doesn’t matter to them that insufficient breastmilk is common. And it certainly doesn’t matter that aggressive breastfeeding promotion harms literately tens of thousands of infants each year. The only thing that matters to them it that delightful hit of dopamine that occurs every time they declare their inherent superiority — not, heaven forefend because they are bragging — but because they are selflessly educating formula feeding mothers by pointing out their faults.

Lactivists are addicted to self-righteousness. The question they must ask themselves is whether they are capable of kicking the habit.

Two days ago I posted this on Facebook:

“Really, Dr. Shah?

I’m shocked that Neel Shah is a part of a for profit birth website that features advocates of pseudoscience and poor practice, including Ina May Gaskin, Michel Odent, Brad Bootstaylor, Barbara Harper and a chiropractor, among others…

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Who suddenly got skittish?[/pullquote]

https://birthpedia.net/meet-the-contributors/

http://startupcompete.co/startup-…/internet/birthpedia/67399

Today’s Featured Questions include: “How could chiropractic care help you get pregnant?” I’ll answer it for free: It can’t!”

The image comes from their beta site that was up and running.

Dr. Shah wasn’t merely one of the contributors; he featured prominently in their promotional materials:

“Imagine having a Harvard OBGYN answer your specific question/concern for only $8 a month. We are changing how providers and patients intake information about birth where any pregnant woman can get answers by qualified professionals” – Co-Founder Justine Tullier

Expectant Parents want quick answers from a trusted source. Our qualified birth professionals are experts in their field and have insight that is backed up by research, evidence and experience. These experts are: PhDs, OBGYNs, Midwives, Lactation Consultants, Doulas, Lawyers, Chiropractors, Fitness Instructors and much more. Their 1 to 2 minutes answers per specific question reflects the trend in decreased attention span of upcoming generations as opposed to long form DVDs.

I also learned that Justine and Gabe Tullier, the founders of Birthpedia, have just taken over Midwifery Today from Jan Tritten. On a now deleted page, the Tulliers boasted:

Midwifery Today will become a vital catalyst for market penetration and thus an extension of Birthpedia.

Midwifery Today has been for years the leading purveyor of homebirth quackery. You may remember Jan, who helped a homebirth midwife canvass a life or death decision on Facebook that resulted in a the death of baby Gavin Michael.

This morning I find that Birthpedia has almost entirely disappeared from the internet. The homepage is still there but has been scrubbed of its experts or indeed any information beyond the fact that it is purportedly launching soon.

The page of contributors is now a 404:

Its business plan on StartupCompete.co was even hidden from the public:

The Facebook page still exists as of this morning and includes such gems about chiropractic as this:

Dr Gena Bofshever has an infectous personality to go along with her thorough chiropractic skills to help women who want to get pregnant by making the organs in their body easier to talk with their brain.

WTF??!!

So what happened to Birthpedia? Are they no longer planning to promote quackery? Who suddenly got skittish?

I’ll be searching for answers.