There is nothing more satisfying than having your work reach the mainstream. It is truly thrilling to read people expounding on the themes that I have blogged about for over a decade and collected in my book Push Back: Guilt in the Age of Natural Parenting. But it’s a little disconcerting to see it in a major newspaper under the byline of one of my Twitter followers but missing attribution to me.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It’s thrilling to see my ideas succeed and be embraced by others, but a brief attribution would have been appreciated.[/pullquote]

Imagine my surprise to see today’s piece in the LA Times, Is ‘natural motherhood’ more feminist? by Lizzie Garrett Mettler. It’s a question I’ve asked repeatedly on this blog and in my book.

Here’s what I read in the LA Times:

Dr. Fernand Lamaze, who popularized the technique for breathing through contractions, ranked women’s childbirth performance from “excellent” to “complete failure” on the basis of their restlessness and screams…

Grantly Dick-Read, an evangelical Christian who wrote the best-selling book “Childbirth Without Fear,” once wrote: “Woman fails when she ceases to desire the children for which she was primarily made. Her true emancipation lies in freedom to fulfill her biological purposes.”

William Sears, who coined the term “attachment parenting,” spent most of his life as a Christian fundamentalist and believed his technique to be God’s design for raising children. In his 1997 book “The Complete Book of Christian Parenting and Child Care,” Sears opposed the idea that women belong in the workplace…

Even the female icons of the movement are overtly traditional. La Leche League, the group that gave rise to modern “lactivism,” was started by seven Catholic housewives who advocated for a return to breastfeeding and were also opposed to mothers working outside the home…

Not only are these my ideas, expressed very similarly to the way I have expressed them, but Mettler describes them using words similar to those I have used.

To me, the approach feels retrograde. It further entrenches women in the home as primary caretakers, places much of their value on their bodies, and makes it even more difficult for them to work.

I’m thrilled that Mettler thinks so highly of my work and clearly agrees with much of it. I’m disappointed, however, that she didn’t attribute it to me.

Don’t get me wrong, it’s not plagiarism since nothing is quoted exactly. And it’s not a copyright violation because you can’t copyright ideas. But it is my work and acknowledging that would have been appropriate.

I guess ideas can grow up and move away just like children can. After years of caring and worrying, it’s thrilling and deeply gratifying when you see your children succeed emotionally, educationally and financially, but a little thank you every now and then never hurts. It’s also thrilling and deeply gratifying to see my ideas succeed and be embraced by others, but a brief attribution would have been appreciated.

Winston Churchill famously noted:

A lie gets halfway around the world before the truth has a chance to get its pants on.

And that was before lies traveled at the speed of the internet.

While the internet has brought many improvements to our lives, it has dramatically empowered liars. That is especially true of social media like Facebook and Twitter. There’s no better example than the anti-vaccine movement. Anti-vaccine social media is nothing more than peer to peer sharing of ignorance and fear.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]You have to be mindbogglingly unsophisticated to imagine that the “dangers” of vaccines are simultaneously top secret AND circulating on Facebook.[/pullquote]

The anti-vaccine movement has a perfect record. In the 200 plus years of its existence, it has never been right about anything.

Vaccination was less than a decade old in 1802 when Gillray created his etching The Cow Pock for the Anti-Vaccination Society.

…[S]atirist James Gillray caricatured a scene at the Smallpox and Inoculation Hospital at St. Pancras, showing cowpox vaccine being administered to frightened young women, and cows emerging from different parts of people’s bodies. The cartoon was inspired by the controversy over inoculating against the dreaded disease, smallpox. Opponents of vaccination had depicted cases of vaccinees developing bovine features and this is picked up and exaggerated by Gillray…

In other words, the first known accusation of anti-vaxxers is that vaccines would turn its recipients into cows. The etching was an early form of social media designed to spread the ignorance and fear of anti-vaxxers to others. Ignorance because they didn’t understand the basic concepts of immunology and fear at what they could not understand.

Over the years, the message has been changed repeatedly, but each has had one factor in common with all those they came before. Every single claim has been a lie that has no basis in science and has been thoroughly debunked. No matter!

By 1884, anti-vaxxers were no long claiming that vaccines turned people into cows, merely that vaccination killed babies.

As an article in the Atlantic explains, even some scientists believed and disseminated anti-vaccine nonsense:

“Every day the vaccination laws remain in force parents are being punished, infants are being killed,” wrote Alfred Russel Wallace, a prominent scientist and natural selection theorist, in a vitriolic monograph against mandatory vaccination in 1898. He accused doctors and politicians of pushing for vaccination based on personal interest without being sure that the vaccinations were safe…

Sound familiar? Disgraced physician Andrew Wakefield is merely the latest in a long line of purveyors of anti-vaccine lies.

These liars have been tremendously empowered by the internet, which allows lies to travel ever faster and in new and insidious ways. It used to be hard for crackpots to be heard; the internet makes it easy. Social media makes it even easier by passing the nutty theories directly from trusted friends, acquaintances and admired celebrities.

Why does anyone believe this nonsense? One factor that all anti-vaxxers have in common is profound ignorance about immunology, science and statistics. They don’t understand the principles of immunity, the way in which vaccines work, and they don’t know how to read scientific research, analyze statistics, or weigh competing claims. That makes them easy prey for quacks and charlatans.

The other factor is fear. People fear what they don’t understand. Those who lack education fear being manipulated by scientists. Those who feel powerless fear being manipulated by the government. Untold millions fear being manipulated by corporations. They manage their fear by resorting to ludicrous conspiracy theories, pretending they have “done their research” and obtained access to secret information they can use to protect themselves.

But it’s not just ignorance and fear that makes it possible. There is one personal characteristic that is shared by anti-vaxxers everywhere — a stunning lack of sophistication.

You have to be remarkably unsophisticated to believe what you read on random Facebook pages and posts shared by your friends.

You have to be remarkably unsophisticated to imagine that the every government in the world and every pharmaceutical company is engaged in a conspiracy that involves literally millions of people and is capable of keeping word of the conspiracy from getting out.

You have to be remarkably unsophisticated to think that doctors, scientists and pharmaceutical executives willingly risk their own children’s lives by giving them “harmful” vaccines as a ruse to hide the secret dangers of vaccines.

You have to be mindbogglingly unsophisticated to imagine that the “dangers” of vaccines are simultaneously top secret AND circulating on Facebook.

Today’s anti-vaxxers would probably laugh at the naïveté of the original anti-vaxxers who thought vaccines would turn them into cows. The sad truth is that they are just as naive and just as foolish to think that vaccines will make their children autistic or that every illness or personality quirk is a “vaccine injury.” Their imaginations spin different horrors but the ignorance, fear and lack of sophistication remains the same.

The ultimate irony is that anti-vaxxers think they are educated by social media, but anti-vax social media makes them stupid. It is nothing more than peer to peer sharing of ignorance and fear.

The lactation community is tearing itself apart over an issue of ideological purity and no one could be happier about it than I am.

Lactivism is a cult, and like most cults, it places a premium on ideological adherence and punishes those who don’t demonstrate appropriate ideological purity.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactivists are circulating a petition designed to humiliate and shame Ruth Lawrence, MD, a giant in the field of breastfeeding research.[/pullquote]

Exhibit A: A Change.org petition designed to humiliate and shame Ruth Lawrence, MD, a giant in the field of breastfeeding research, signed by over 2000 lactivists.

What did the 90+ year old Dr. Lawrence do to merit such treatment? She dared to speak, along with other prominent breastfeeding researchers, at a conference sponsored by Satan Nestle, more accurately the affiliated Nestle Nutrition Insitute. Quelle horreur!

The Nestle Nutrition Institute held their 90th Nestle Nutrition Institute Workshop in Switzerland from October 30 to November 1, 2017…

Several prominent breastfeeding and human milk researchers spoke at the event, thereby offering their own reputations and credibility to the brand whose egregious infant formula and baby food marketing practices have been heavily documented for decades.

How should the elderly Dr. Lawrence and the other miscreants be humiliated disciplined?

We call for the following:

– Academy of Breastfeeding Medicine to remove Dr. Ruth Lawrence from their Board of Directors

– La Leche League International to remove Dr. Ruth Lawrence and Dr. Paula Meier from the Health Advisory Council

– International Society for Research in Human Milk and Lactation (ISRHML) to remove Lars Bode (current President of ISRHML) and Sharon Donovan (President elect of ISRHML)

How this will promote breastfeeding? It won’t, but it is just a blatant attempt to enforce ideological purity, a central feature of any cult.

According to Google Dictionary, a cult is a “system of religious veneration and devotion directed toward a particular figure or object.”

• Lactivism is a cult because it displays a near religious devotion to breastfeeding, treating it as perfect for all babies, at all times, in all situations.
• Lactivism is a cult because it frames any criticism of breastfeeding, no matter how minor, as opposition to breastfeeding.
• Lactivism is a cult that shames those who dare deviate from cult orthodoxy; hence the shaming of women who can’t or don’t breastfeed.
• Lactivism is a cult because it demands ideological purity.

The demand of ideological purity is critical.

The world is depicted as black and white, with little room for making personal decisions based on a trained conscience. One’s conduct is modeled after the ideology of the group, as taught in its literature. People and organizations are pictured as either good or evil, depending on their relationship to the cult.

Universal tendencies of guilt and shame are used to control individuals … There is great difficulty in understanding the complexities of human morality, since everything is polarized and oversimplified. All things classified as evil are to be avoided, and purity is attainable through immersion into the cult’s ideology.

What has Dr. Lawrence contributed to the field of breastfeeding research? For many years she was the field of breastfeeding research.

At the University of Rochester School of Medicine, with which she has been closely associated since 1949, she is a professor of Pediatrics and Obstetrics and Gynecology and a member of the Division of Neonatology. She also is Medical Director of the Breastfeeding and Human Lactation Study Center, which she founded in 1985, and Medical Director of the Finger Lakes Regional Poison and Drug Information Center, which she has guided since 1958-after helping to organize it in 1954, the second such center to open in the country.

Author of Breastfeeding: A Guide for the Medical Profession , the standard reference work since its 1979 publication, and many articles, chapters and reviews, Lawrence is a founding member and a past president of the Academy of Breastfeeding Medicine. As a member of the American Academy of Pediatrics work group on breastfeeding, she participated in the preparation of the Academy’s statement on breastfeeding and human lactation, and is now on the Executive Committee of the Academy’s Section for Breastfeeding.

But apparently none of that matters. She consorted with Satan and must be punished.

Make no mistake, Nestle is Satan in the lactivist cosmology. If it did not exist, it would have had to be invented for the purpose. Yes, Nestle did unconscionable things fifty years ago in Africa. In an attempt to increase market share, they promoted formula (and got women “hooked” on it) knowing that the only water that would be used to make it was contaminated and that many of them could not afford it and therefore eventually diluted it. Many babies died as a result.

But that was fifty years ago. I doubt that anyone responsible for that ethical outrage is even alive today, let alone still working at Nestle. No matter! Nestle has continue to serve as a convenient foil for the breastfeeding industry. It allows lactivists to imagine that formula itself is evil because it is produced by a company — though not only that company — that once allowed unethical and deadly business practices.

The demonization of formula is central to lactivism, as if any food should ever be demonized let alone one that has saved literally millions of lives. If breastfeeding disappeared tomorrow, very few babies would be harmed as a result; if formula disappeared tomorrow, millions would die.

But this incident isn’t merely amusing for those outside the lactivist cult, it is also instructive. There is little more important to the contemporary lactivist movement than the work and dedication of Dr. Ruth Lawrence. She is a pioneer and an intellectual giant within breastfeeding research. I don’t always agree with her, but I have the most profound respect for her.

The fact that lactivists would shame and humiliate her because she didn’t demonstrate sufficient ideological purity tells you that breastfeeding is more important to them than people. It really doesn’t matter to them whom they hurt, even one of their own. We should not be surprised then that they are willing to hurt babies and mothers — even let them die — because of their cult like veneration of breastfeeding.

During the Vietnam War, a military officer remarked about the village of Ben Tre:

“It became necessary to destroy the town to save it.

The quote came to epitomize the brutality and absurdity of the war itself, a war based on killing people in order to “save” them.

I was reminded of that quote by Dr. Melissa Bartick’s irresponsible and hypocritical opinion piece in Maternal Child Nutrition, Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution. Bartick promotes the deadly practice of co-sleeping in order to support breastfeeding. Apparently she is blind to the absurdity of letting babies die in order to save them.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Dr. Melissa Bartick promotes the deadly practice of co-sleeping.[/pullquote]

When I first saw the evidence about the deadly risks of co-sleeping, I was not persuaded. I had co-slept with my own babies and it was difficult to contemplate that I might have put them at risk. Over the years, however the evidence has become overwhelming and I have come to understand just how deadly co-sleeping can be.

According to the American Academy of Pediatrics:

…[B]ed-sharing is associated with an increased risk of SIDS; a recent meta-analysis of 11 studies investigating the association of bed-sharing and SIDS showed a summary OR of 2.88 (95% CI: 1.99–4.18) with bed-sharing. Furthermore, bed-sharing in an adult bed not designed for infant safety, especially when associated with other risk factors, exposes the infant to additional risks for unintentional injury and death, such as suffocation, asphyxia, entrapment, falls, and strangulation. Infants younger than 4 months194 and those born preterm and/or with low birth weight are at the highest risk, possibly because immature motor skills and muscle strength make it difficult to escape potential threats. In recent years, the concern among public health officials about bed-sharing has increased, because there have been increased reports of SUIDs occurring in high-risk sleep environments, particularly bed-sharing and/or sleeping on a couch or armchair.

It is incontrovertible that bed sharing nearly triples the risk of infant death from SIDS. But apparently for Bartick that pales into insignificance compared to the benefits of promoting breastfeeding. She seems to believe that it makes sense to let babies die in order to save them.

Her “argument” is an inane exposition of the naturalistic fallacy, the fallacy that because something was done in nature, it always and forevermore ought to be continued.

Recommendations enforcing separate sleep are based on 20th century Euro‐American social norms for solitary infant sleep and scheduled feedings via bottles of cow’s milk‐based formula, in contrast to breastsleeping, an evolutionary adaptation facilitating the survival of mammalian infants for millennia. Interventions that aim to prevent bedsharing, such as the cardboard baby box, fail to consider the implications of evolutionary biology or of ethnocentrism in sleep guidance…

As I explained yesterday, only someone who doesn’t understand evolution would offer such a foolish justification for risking babies’ deaths.

Bartick appears to believe that evolution produces perfection and therefore, any deviation from the past is a deviation from perfection. But evolution does not produce perfection; it is based on survival of the fittest. By definition, in the state of nature, some will live, many will die. Why would we want to copy that?

From an evolutionary perspective, the most successful animals are those who can adapt to new environments, not those who are slavishly devoted to recapitulating the behavior of their ancestors. It doesn’t matter what happened in the past, only how well the animal can cope with present conditions.

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, with soft bedding, some of us having smoked tobacco, or ingested alcohol or pharmaceuticals.

The parents who will be most successful evolutionarily are those who let their offspring sleep in a separate bed, on a firm surface, with no bedding or soft toys.

But Bartick isn’t interested in what’s good for babies, she’s interested in what is good for breastfeeding.

She writes

Recognizing breastsleeping as the evolutionary and cross‐cultural norm entails re‐evaluating our research and policy priorities, such as providing greater structural support for families, supporting breastfeeding and safe co‐sleeping, investigating ways to safely minimize separation for formula‐fed infants, and mitigating the potential harms of mother–infant separation when breastsleeping is disrupted…

Pro-tip for Dr. Bartick: a dead baby can’t breastfeed.

Promoting co-sleeping is the equivalent of destroying babies in order to save them.

It’s also extraordinarily hypocritical.

Bartick and other professional lactivists have implied that women who choose formula feeding because breastfeeding causes pain, frustration and exhaustion are “selfish” women more concerned for their own convenience than for their baby’s wellbeing.

In promoting bed sharing, Bartick notes:

Research shows that bedsharing breastfeeding mothers nurse their infants 5.75 times during the night (often without realizing it), compared to 2.5 times a night for moms and babies who do not share a bed.

There is nothing inherent in sleeping separately that prevents a mother from breastfeeding exclusively. Bed sharing just makes breastfeeding more convenient. But according to lactivist logic, if convenience is not an acceptable reason for using formula instead of breastfeeding, it couldn’t possibly be an acceptable reason for refusing to get out of bed to nurse an infant as often as he or she wants.

Lactation professionals have no trouble telling women to set an alarm and pump multiple times during the night in order to boost supply, why don’t they tell breastfeeding mothers to set an alarm and get up and breastfeed 5.75 times a night to maintain breastfeeding while avoiding infant death? Can it be that breastfeeding mothers are simply too lazy and selfish?

Bartick writes:

Moving forward, our frame of reference in determining risk and public policy to manage risk must be normative human physiology …

Wrong! Our frame of reference in determining risk ought to be scientific evidence, not what our ancestors did in the past.

Anything else amounts to letting babies die in order to save them.

Yesterday a young woman thought she would call me out on Twitter. It didn’t go quite as she had planned; she ended up looking very foolish.

In the rant that followed, McGann who apparently prides herself on her knowledge of evolution revealed that she doesn’t understand evolution. A lot of natural parenting advocates have the same problem.

The key mistake is embodied in this tweet:

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Evolution teaches us that those who adapt and change are most successful, and those who insist on copying their ancestors will end up extinct.[/perfectpullquote]

#Breastfeeding is the result of a 7 million-year, randomized, double-blind, large-scale, longitudinal study called natural selection. This is not Appeal to Nature, but a sign post pointing right at where we should be directing the research.

So many errors in so few words:

• evolution is not an RCT since evolution acts on all possible variables at once;
• evolution does not create perfection;
• evolution leads to survival of the fittest; by definition many will die.

But the key mistake, one beloved of natural parenting advocates, is the idea that we evolved for a particular environment and we should do all we can to recapitulate that environment. That’s the exact OPPOSITE of what evolutionary theory tells us. It goes back to one of Charles Darwin’s most important discoveries about the finches in the Galápagos Islands.

A few million years ago, one species of finch migrated to the rocky Galapagos from the mainland of Central or South America. From this one migrant species would come many — at least 13 species of finch evolving from the single ancestor.

This process in which one species gives rise to multiple species that exploit different niches is called adaptive radiation. The ecological niches exert the selection pressures that push the populations in various directions. On various islands, finch species have become adapted for different diets: seeds, insects, flowers, the blood of seabirds, and leaves.

The ancestral finch was a ground-dwelling, seed-eating finch. After the burst of speciation in the Galapagos, a total of 14 species would exist: three species of ground-dwelling seed-eaters; three others living on cactuses and eating seeds; one living in trees and eating seeds; and 7 species of tree-dwelling insect-eaters.

The finches can teach us critical lessons about evolution.

1. Fitness is not static.

As conditions changes, fitness changes. And conditions always change, whether it is climate, pressure from other species, local events like volcanic eruptions, etc. There is no such thing as an animal that is “perfectly fit” because there is no such thing as a static environment.

Had Darwin’s finches behaved like natural parenting advocates, they would have whined that they were adapted for ground dwelling and seed eating and therefore, they should continue living on the ground and eating seeds regardless in the dramatic change in conditions.

2. Fitness is tied to the environment.

When the ancestral finch migrated to the Galápagos Islands, its fitness was determined by the environment there. In most cases, the ancestral finch wasn’t particularly fit at all, despite its fitness on the mainland. Evolution caused the finches to evolve new traits, specific to the specific environment.

How successful do you think the seed eating finches were on islands that had very few seeds of the type they had been evolved to eat? Not very. That’s why they evolved characteristics like changes in beaks to allow them to eat different seeds and, in some cases, switched from seeds to insects.

How successful do you think the ground dwelling finches were on islands that had ground dwelling predators? Not very. That’s why they evolved to live in both cactuses and trees.

3. The most successful animals are those who can adapt, not those who remain unchanged. It doesn’t matter what happened in the past, only how well the animal can cope with present conditions.

If we anthropomorphize the finches, we can see just what is wrong with the philosophy of natural parenting.

Suppose the ancestral finches who arrived in the Galapagos had surveyed the situation on each island and announced:

“We were evolved to live on the ground and eat seeds. Therefore, we will continue living on the ground and eating seeds and pretend we are still on the mainland.

“Any finches who sample the different local seeds are benighted fools and inferior to us. They aren’t adapated to eat those seeds so they will certainly not thrive but will become obese, get cancer and auto-immune diseases and die out quickly. We will be the ones who survive.

“Any finches who choose to live in trees or, heaven forefend on ugly cactuses, are also fools and inferior to us. We were evolved to live on the ground and so we will continue to live on the ground, no matter the existence of local predators. We simply need to “trust” that the ground is safe and that will make it safe.

“Nature has rendered us perfectly evolved and all we have to do is live like we have always lived.”

They would have been wrong in every conclusion. The finches destined to be most successful were those who abandoned the way they had evolved and sought out new food sources and new places to live.

It’s not hard to see the parallels with natural parenting.

Lactivists are equivalent to finches who insisted on eating seeds because they always ate seeds. In their view, breastfeeding must be superior because humans have always breastfed. But we no longer live in the state of nature and haven’t for more than 10,000 years. The parents who will be most successful evolutionarily are those who teach their offspring to take advantage of new foods like formula when beneficial. In nature, many babies died due to insufficient breastmilk; those babies can now survive on formula. They are fitter for the current environment.

Parents who advocate co-sleeping are equivalent to finches who insisted on living on the ground even though there were new predators on the ground. In their view, co-sleeping must be superior because humans co-slept in the past. But even if that were the case, they co-slept on the bare ground in the cold. Humans haven’t slept on the bare ground in the cold since fire was mastered. Just like the finches found ground predators on new islands, we now sleep in ways that are harmful to babies: on soft surfaces, with soft bedding, some of us having smoked tobacco, or ingested alcohol or pharmaceuticals. The parents who will be most successful evolutionarily are those who let their offspring sleep in a separate bed, on a firm surface, with no bedding or soft toys.

We have no trouble understanding that finches who insisted on living like their ancestors despite a new enviroment became evolutionary failures. Similarly, natural childbirth advocates who insist that giving birth like our foremothers is “best” are destined to be evolutionary failures as their children die at homebirths or because they refused routine prenatal testing and interventions.

The ultimate irony is that evolution teaches us that those who adapt and change are most successful, and those who insist on copying their ancestors will end up extinct.

It happened again! I wrote about something and activists rush to demonstrate exactly what I was talking about.

Yesterday I mentioned the rabid hatred that lactivists direct toward the Fed Is Best Foundation. With three little words, “Fed Is Best,” Christie del Castillo Hegyi, MD and Jody Segrave Daly RN, IBCLC have blown apart lactivist frames with a more accurate frame, one that doesn’t marginalize and silence women who can’t or don’t breastfeed.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The Becoming Breastfeeding Friendly group at the YSPH are apparently unfamiliar with the breastfeeding literature.[/pullquote]

In other words, Jody and Christie (both of whom breastfed) are whistle blowers. And like most people who blow the whistle on any industry, they have been subjected to industry sponsored abuse

The Yale School of Public Health has joined the pile on. Surprisingly for a group of people who run a program called Becoming Breastfeeding Friendly, they don’t seem to know very much about breastfeeding.

Let’s state the situation is simple terms. Breastfeeding, which has been promoted as the optimal nutrition for all babies, is actually resulting in the iatrogenic brain damage and preventable deaths of babies. The breastfeeding industry, instead of moving to prevent these injuries and deaths, is reacting with fury.

As I’ve written in the past, it reminds me of the response of Merck when the news became public that Vioxx, a blockbuster pain reliever, was leading to preventable deaths: deny, defy and decry. In this case, they are attacking Kavin Senapathy,who wrote in Forbes about the World Health Organizations declaration that breastfeeding related brain damage and deaths are “not a priority.” Through her, they are going after the Fed Is Best Foundation.

The Yale authors write:

In Kavin Senapathy’s opinion article, the suggestion that the 2017 revised WHO Baby Friendly Hospital Initiative (BFHI) guidelines place newborns at risk of starvation or severe complications is not supported by the evidence of decades of research in the area of breastfeeding and human milk. We are deeply concerned because it could lead to serious misunderstandings for expecting parents and the general population.

The tactic of denial is typically the first step employed by Big Pharma when one of its drugs comes under attack. The drug company claims that the scientific research did not show that the drug was harmful. It’s as if we are supposed to pretend the deaths didn’t happen because they weren’t anticipated by the research.

In the case of Vioxx, the scientific research DID show that Vioxx led to unanticipated cardiac deaths; that research was suppressed. In the case of breastfeeding, the research DOES show that breastfeeding leads to unantipicated brain injuries and deaths; the members of the Yale Breastfeeding Friendly group are either unaware of that research or choose to ignore it.

They write:

We agree with the notion that we must acknowledge the existence of the problem of insufficient breastmilk. However, the article fails to consider that this problem, which is manifested as an inadequate supply of breastmilk needed to properly feed one’s baby (Neifert, 2001; Wilson-Clay & Hoover, 2013), is most often characterized by a phenomenon known as perceived insufficient milk (Safon et al., 2017; Segura-Millán et al., 1994). Also known as insufficient milk syndrome, in the vast majority of cases it is the result of widespread lack of access to both prenatal and postnatal optimal breastfeeding support and lactation management rather than primary biological reasons (Gussler & Briesemeister, 1980; Tully & Dewey, 1985).

Horrifyingly, the group is gaslighting women whose babies have been brain injured and died as a result of insufficient breastmilk. Lactivists have attempted to frame the problem of insufficient breastmilk as a figment of mothers’ imagination.

Sure, insufficient breastmilk is not a problem according to lactivist theory, but then Vioxx was not a problem according to Big Pharma theory, either. But just as in the case of Vioxx, in practice, insufficient breastmilk DOES injure and kill babies and the perception of insufficient breastmilk is NOT a figment of womens’ imagination.

Let’s look at the real evidence, not the theory.

Insufficient breastmilk is common, not rare.

In 2010, the Academy of Breastfeeding Medicine acknowledged:

It is important to recognize that not all breastfed infants will receive optimal milk intake during the first few days of life; as many as 10–18% of exclusively breastfed U.S. newborns lose more than 10% of birth weight.

There is a biomarker for insufficient breastmilk.

From a 2001 paper:

High levels of sodium in breast milk are closely associated with lactation failure. One study showed that those who failed lactation had higher initial breast milk sodium concentrations, and the longer they stayed elevated, the lower the success rate.

Insufficient breastmilk is NOT a figment of women’s imagination.

This was confirmed in a 2017 paper that also showed that women who felt they had insufficient breastmilk were more likely to have the biomarker present.

…[E]levated day 7 breast milk Na:K occurred in 42% of mothers with a day 7 milk supply concern, compared with 21% of mothers without a day 7 milk supply concern (unadjusted relative risk, 2.0; P = .008) (Table II). The unadjusted odds of elevated Na:K were 2.7 greater (95% CI, 1.3-5.9) with maternal report of milk supply concern (refer- ence = no concern, P = .01) and further increased after ad- justment for maternal ethnicity (3.4; 95% CI, 1.5-7.9; P = .003).

The potential brain threatening and life threatening consequences include kernicterus, hypernatremic dehydration and severe hypoglycemia.

Kernicterus, thought to have nearly disappeared, is making a comeback.

Dr. Lawrence Gartner revealed to other lactation professionals in a 2013 lecture, 90% of cases of kernicterus (jaundice induced brain damage) are caused by insufficient breastmilk.

The Academy of Breastfeeding Medicine reported in a 2017 paper:

In the U.S. Kernicterus Registry, a database of 125 cases of kernicterus in infants discharged as healthy newborns, 98% of these infants were fully or partially breastfed …

Neonatal hypernatremic dehydration is more common than SIDS.

From 2016 paper :

In a retrospective study in the United Kingdom, the frequency of breastfeeding-associated neonatal hypernatremia was found to be greater than all-causes combined of hypernatremia among late preterm and term newborns.81 In the mentioned report, the incidence of sodium level ≥ 160 was 71 per 100 000 breastfed infants (1 in 1400).

The consequences include death and potentially devastating neurologic injury as this 2017 study explains:

In our study 7 out of 65 patients died as a result of complications of hypernatremia. There was a significant correlation between severity of hypernatremia and mortality (p = 0.001). All who died had serum sodium concentration >160 mmol/L…

All infants in the control group were developmentally normal at ages 6 and 12 months, but in the case group 25% and 21% had developmental delay at 6 and 12 months, respectively. At 18 months the incidence of developmental delay was 3% for the control group and 19% for case group, and at 24 months 12% of case infants had developmental delay versus none for the control group…

Hypoglycemia also injures and kills babies.

A 2017 paper reports that the UK has paid out $250 million dollars for brain injuries due to hypoglycemia, nearly all cases the result of insufficient breastmilk.

I’m going to charitably assume that the Yale breastfeeding group is simply unaware of the depth and breadth of the literature on insufficient breastmilk and the brain injuries and deaths it causes. The alternative would be that the group is actively concealing the latest research findings in order to keep women in the dark about the deadly risks of breastfeeding.

They close their piece with a paragraph that would be laughable if the issue weren’t so serious:

Overall, an extensive review of the literature was warranted but not employed in writing this opinion piece. We need to provide mothers with high-quality, unbiased and uncompromised breastfeeding support both during and after pregnancy…

The people who failed to do an adequate literature review were the folks from Yale.

The bottom line, though, is this: If Yale School of Public Health group doesn’t have command of the breastfeeding literature, especially the latest scientific papers, they have no business criticizing those who do. Otherwise that criticism comes across the same way as such efforts on the part of Big Pharma do: attempts to silence whistle blowers in order to keep market share.

A political pollster once said, “If you frame the problem, you own it.”

He meant that if you could convince others to refer to the problem in your terms, you are almost assured of having control over an issue. For example, consider the way people frame abortion. Those who think women should be allowed to control their own reproductive organs refer to themselves as “pro-choice.” Abortion opponents recognized early on that “anti-choice” would not make a good moniker, so they refer to themselves as “pro-life,” despite the fact that restricting abortion leads to maternal deaths. Language can be used to signal views and to attempt to persuade others to those views.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breast Is Best frames women who can’t or don’t breastfeed as inferior, abnormal, lazy liars; Fed Is Best frames them as loving mothers.[/pullquote]

Lactivists have attempted to use language in this way and not merely to signal their views or to persuade others to those views. They also use language to marginalize any woman who does not share their views. That is both anti-feminist and unethical.

Consider:

Lactivists frame breastfeeding as “best” despite the fact that for many babies and mothers it isn’t best at all. “Breast is Best” is arguably the most powerful frame that lactivists have employed. While it is theoretically meant to refer to the relative merits of breastmilk and infant formula, its secondary purpose is to marginalize women who can’t or don’t breastfeed. What kind of mother gives her infant “second best”? Only a bad mother. In three simple words, lactivists have labeled women who use formula as bad mothers.

Never mind that breastmilk is NOT best for all babies. Never mind that many women cannot make enough breastmilk to fully nourish an infant. Lactivists have language to erase those facts.

For many years, lactivists have framed insufficient breastmilk as rare. That’s not what the scientific evidence shows, but lactivists have told that falsehood so many times that many of them now believe it themselves. It’s a falsehood with a specific purpose; it is meant to characterize women who report low supply as liars. It’s hard to think of a more effective way to silence women who can’t breastfeed then to imply that they are liars who are only trying to justify the fact that they are bad mothers.

Lactivists frame all breastfeeding problems as due to “lack of support.” This serves two purposes. One: to marginalize and silence women who don’t want to use their breasts to nourish their babies. It is basically an accusation of false consciousness. The second purpose is economic. If successful breastfeeding is simply a matter of support, the reasoning goes, we should just hire more breastfeeding support people.

Lactivists have framed promoting breastfeeding as “normalizing” breastfeeding. The implication is not subtle: women who can’t or don’t breastfeed are abnormal.

Social media have become an important components in an all out effort to marginalize and silence women who can’t or don’t breastfeed. They intensively mediate breastfeeding discourse, allowing only that discourse that supports the preferred frames.

Lactivists frame breastfeeding supportive websites and Facebook pages as islands within a culture that is not supportive of breastfeeding. That’s a convenient fiction; fiction because it’s hard to imagine a society that has ever been more supportive of breastfeeding than this one and convenient because it allows for the literal silencing of women who can’t or don’t want to breastfeed by deleting their posts and comments. There’s no better way to promote the frame that breastfeeding problems are rare than by literally erasing women’s attempts to share those problems.

Lactivist allow the mention of breastfeeding difficulties if they can frame them as surmountable. Women are allowed to present their problems on social media if they are asking for the guidance of the group, blame themselves, acknowledge that with enough effort they can fix the problem, and continue breastfeeding regardless of whether their babies are dehydrated, jaundiced and starving to death.

Lactivists frame pediatricians and any other providers who are not explicitly commmitted to the agreed upon frames as “uneducated.” This serves a variety of purposes. It frames lactation professionals as having knowledge that others do not have (even though many pediatricians and obstetricians are women who have breastfed). It allows breastfeeding professionals to advise women to ignore pediatricians when they dare to value the health of the baby above the act of breastfeeding and it allows lactivists to silence women who fear for their baby’s health as gullible for believing other providers.

Lactivists frame breastfeeding as both natural (implying ease and an absence of problems) and hypermedicalized: requiring books, classes, coaches, mechanical breast pumps, herbs and pharmaceutical galactologues to increase supply, elimination diets, surgery on babies tongues to correct latch and a raft of expensive consumer goods like breastfeeding pillows, clothing, salves and foods. This double framing means that though breastfeeding is touted as natural, women who aren’t successful at breastfeeding can be portrayed as unwilling to do the hard work and spend the money to succeed.

Lactivists frames are anti-feminist. The frames are deliberately intended to deprive women of choice in infant feeding. The frames are deliberately intended to marginalize women who can’t or don’t breastfeed as inferior, abnormal, lazy and victims of false consciousness.

Lactivists frames are unethical because they put the brains and lives of infants at risk. A substantial proportion of mothers (as many as 1 in 7) cannnot produce enough milk to fully nourish an infant; those babies brains and lives are at risk from hypoglycemia, dehydration, and severe jaundice. The frame that insufficient breastmilk is “rare” is nothing more than a bald-faced lie. The frame that formula supplementation is harmful ignores the science that show judicious formula supplementation increases the odds of extended breastfeeding. The frame that pacifiers interfere with breastfeeding ignores the science that shows that they save infant lives. When lactivists lie, babies die.

The intensive lactivist efforts at framing explain the rabid hatred directed at the Fed Is Best Foundation. With three little words, “Fed Is Best,” Christie del Castillo Hegyi, MD and Jody Segrave Daly RN, IBCLC have blown apart lactivst frames with a more accurate frame, one that doesn’t marginalize and silence women who can’t or don’t breastfeed.

Instead of framing these mothers as inferior, abnormal, lazy liars, Fed Is Best frames them as loving.

Instead of framing them as women who are avoiding their most important responsibility, they frame them as bucking a tide of hostility and abuse to protect their babies above all.

Most importantly, instead of protecting breastfeeding, they protect babies from brain damage and death.

That’s why lactivists save a special frame just for them; Christie and Jody (both of whom breastfed) are framed as anti-breastfeeding when they are really pro babies and mothers.

I wrote Birth plans: worse than useless over 5 years ago but it remains one of the most read, most commented upon pieces on this blog.

A new paper in the “journal” Birth (owned by Lamaze International), Birth plans—Impact on mode of delivery, obstetrical interventions, and birth experience satisfaction: A prospective cohort study by Afshar et al. shows that birth plans are still worse than useless, not merely failures on their own terms, but actually making women feel less satisfied than they would have without birth plans.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Having a birth plan is as effective as having a weather plan for the day of birth.[/pullquote]

Three hundred women were recruited: 143 (48%) had a birth plan. There was no significant difference in the risk of cesarean delivery for women with a birth plan compared with those without a birth plan (21% vs 16%, adjusted odds ratio [adjOR] 1.11 [95% confidence interval (CI) 0.61-2.04]). Women with a birth plan were 28% less likely to receive oxytocin (P < .01), 29% less likely to undergo artificial rupture of membranes (P < .01), and 31% less likely to have an epidural (P < .01). There was no difference in the length of labor (P = .12). Women with a birth plan were less satisfied (P < .01) and felt less in control (P < .01) of their birth experience than those without a birth plan.

It’s really not surprising when you consider that birth plans, like most of natural childbirth philosophy, was conjured from thin air, with no investigation as to whether they worked or if the assumptions behind them were accurate.

… Birth plans were originally introduced in the 1970s as a communication tool. In the 1980s, after criticism of an overly “medicalized” view of childbirth, the World Health Organization went on to classify birth plans in the top category of recommended practices for making pregnancy safer…

But the truth is that birth plans were created by birth paraprofessionals as a way empower themselves and stick a proverbial finger in the eye of obstetricians. Birth plans engender hostility from the staff, are usually filled with outdated and irrelevant preferences, and create unrealistic expectations among expectant mothers. And they don’t work.

This is not news.

Joanne Motino Bailey, CNM et al. in Childbirth Education and Birth Plans, noted:

There are no randomized controlled trials that analyze birth plans …

Brown and Lumley stated that “women who made use of a birth plan were more likely to be satisfied with pain relief, but did not differ from women not completing a birth plan in terms of overall rating of intrapartum care, or involvement in decision making about their care.” Whitford and Hillan found that most women who completed a birth plan found it useful and stated they would write another birth plan in a future pregnancy, although most did not believe it made any difference in the amount of control they felt during labor and many did not think enough attention had been paid to what they had written.

Birth plans do not improve outcomes. As Pennell et al, pointed out in Anesthesia and Analgesia–Related Preferences and Outcomes of Women Who Have Birth Plans:

…Analgesic preferences were reported to be the most important birth plan request. Greater than 50% of women requested to avoid epidural analgesia; however, 65% of women received epidural analgesia. On follow-up, greater than 90% of women who received epidural analgesia reported being pleased…

But most importantly, birth plans increase disappointment. In Is the Childbirth Experience Improved by a Birth Plan?, Lundgren et al. were surprised to find:

… A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving women’s experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery…

Yet in 2017, people keep studying them, apparently hoping that this time the results will be different. Afshar et al. found weren’t:

The World Health Organization, American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics have suggested that birth plans may be a vehicle for women to communicate what their preferences for childbirth are and that birth plans may be associated with improved patient safety and satisfaction. Despite these recommendations, there is little data with respect to the role of the birth plan in facilitating patient-provider communication or the efficacy of the birth plan with respect to mode of delivery.

And:

…[D]espite receiving care consistent with their birth plan, women with birth plans described not feeling in control and were less satisfied with their birth experience than those women without birth plans.

The authors evince surprise about this results, but they shouldn’t. Having a birth plan is like having a weather plan for the day of birth. It is utterly ineffective and very likely to end in disappointment.

Birth plans reflect the fundamental fraud at the heart of natural childbirth advocacy, the insistence that a woman’s experience of childbirth is all in her head and that by planning and directing her thoughts appropriately she can have whatever experience she wants. That makes as much sense as claiming that the weather is all in one’s head and that by planning and directing your thoughts you can have whatever weather you desire.

Birth plans don’t merely fail in their stated aim, there’s no way that they could ever succeed. The key to a safe, satisfying birth experience is flexibility based on the understand that no one can control childbirth. Anything else will inevitably lead to increasing disappointment, not preventing it.

Yes, you read that right, the aggressive promotion of breastfeeding by the Baby Friendly Hospital Initiative has led to an epidemic of newborn brain damage.

No less an authority than Lawrence Gartner, MD, member of the BFHI Board of Directors has admitted that 90% of kernicterus cases are attributable to breastfeeding! Sadly, Dr. Gartner acknowledged it only to other breastfeeding professionals. Parents and pediatricians have been left in the dark.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breastfeeding is responsible for over 90% of jaundice-induced brain damage.[/pullquote]

What is kernicterus?

Children’s Mercy Hospital Kansas City has an easy to understand explanation for lay people:

Kernicterus is a form of brain damage caused by excessive jaundice. The substance which causes jaundice, bilirubin, is so high that it can move out of the blood into brain tissue.

Kernicterus is disastrous for babies:

When babies begin to be affected by excessive jaundice, when they begin to have brain damage, they become excessively lethargic. They are too sleepy, and they are difficult to arouse – either they don’t wake up from sleep easily like a normal baby, or they don’t wake up fully, or they can’t be kept awake. They may have a high-pitched cry, and decreased muscle tone, becoming hypotonic or floppy with episodes of increased muscle tone (hypertonic) and arching of the head and back backwards. As the damage continues they may arch their heads back into a very contorted position known as opisthotonus or retrocollis, they may develop fever, and they may even develop seizures (convulsions).

The jaundice is caused by breastfeeding induced starvation.

It is important to understand that In 2017, kernicterus is an iatrogenic injury. It is astoundingly easy to prevent; judicious formula supplementation will prevent it 100% of the time.

The slides for Dr. Gartner’s lecture to the California Breastfeeding Summit are chilling.

The most common cause of kernicterus used to be Rh incompatibility; and Rh- negative mother attacked the red blood cells of her Rh+ baby. With the advent of Rhogam, Rh incompatibility is only rarely a problem.

As Dr. Gartner pointed out:

We thought kernicterus had disappeared! It has not! … What types of infants are still having kernicterus? All kinds of children – but one type has emerged recently as predominant.

Breastfed infants: 90% of all cases of kernicterus especially with weight loss in excess of 10%.

The Academy of Breastfeeding Medicine suggests that the contribution of breastfeeding starvation may be even higher.

In the U.S. Kernicterus Registry, a database of 125 cases of kernicterus in infants discharged as healthy newborns, 98% of these infants were fully or partially breastfed …

As a result of aggressive breastfeeding promotion, those babies were allowed to starve.

Strong evidence suggests that increased serum bilirubin in the first few days is highly correlated with suboptimal enteral in- take; serum bilirubin concentrations are highly associated with greater weight loss in breastfed infants.

In summary:

• We are experiencing an epidemic of jaundice-induced brain damage (kernicterus) in newborns.
• Between 90-98% of cases are the direct results of aggressive breastfeeding promotion.
• In every one of those cases, brain damage could have been completely prevented by formula supplementation.
• Kernicterus is almost non-existent in formula fed babies.

If we care about babies, the solution is obvious: Every baby should be aggressively monitored for adequate breastmilk intake and when there is any doubt about intake, babies should be supplemented with formula.

We could EASILY prevent 100% of breastfeeding starvation jaundice by feeding at risk babies (those who have lost 10% of body weight or have elevated bilirubin above physiological levels). It would cost very little, only a tiny fraction of the cost of hospital readmissions, phototherapy, and subsequent treatment for brain injuries.

But lactation professionals are apparently more interested in promoting breastfeeding than in promoting infant health.

It may be necessary to supplement with infant formula if neither own mothers’ milk nor donor human milk is available. The impact of introducing formula to an exclusively breastfed infant must be considered.

Wait, what? We are talking about preventing brain damage!

From the paper Impact of bilirubin-induced neurologic dysfunction on neurodevelopmental outcomes:

Kernicterus most usually is characterized by choreoathetoid cerebral palsy (CP), impaired upward gaze, and sensorineural hearing loss, whereas cognition is relatively spared…

But levels below that needed to cause kernicterus can also result in brain injuries:

Clinically, BIND [bilirubin induced neurologic dysfunction] may manifest after the neonatal period as developmental delay, cognitive impairment, disordered executive function, and behavioral and psychiatric disorders…

There is no possible impact of formula on breastfeeding that is even remotely worth considering compared to preventing cerebral palsy, hearing loss, cognitive impairment, disordered executive function and other behavioral and psychiatric disorders. The benefits of breastfeeding in industrialized countries are trivial and certainly pale into insignificance besides these risks.

What is going on here?

Sadly, a group of health professionals has become so invested in a process – breastfeeding – that they are willing to destroy baby’s brains in order to protect that process.

Indeed, as Kavin Senapathy reported in Forbes:

When asked [by the Fed Is Best Foundation] whether WHO plans to inform mothers of the risks of brain injury from insufficient breast milk, and that temporary supplementation can prevent complications, Dr. Rollins responded that this recommendation was not identified as a “top priority.”

The bottom line is that we’ve spent the last 30 years aggressively promoting breastfeeding and all we have to show for it is an epidemic of iatrogenic brain damage.

Protecting babies brains is infinitely more important than protecting breastfeeding.

 

As of today, 4300 parents and professionals have signed the petition to implore the WHO to make breastfeeding induced brain injuries a priority. Please join them.

One of the great ironies of the philosophy of attachment parenting is that is contradicts what we know about infant attachment.

The founding studies of Attachment Theory were led by scientists like John Bowlby, Harry Harlow and D.W. Winnicott. Their most critical finding was that human contact was more important than any particular parenting practice. For example, Harry Harlow’s monkey experiments demonstrated beyond doubt that mothers matter more than milk.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breastfeeding doesn’t create the bond between mother and child, comfort does.
[/pullquote]

We produced a perfectly proportioned streamlined body stripped of unnecessary bulges and appendices… The surrogate was made from a block of wood, covered with sponge rubber, and sheathed in tan cotton terry cloth. A light bulb behind her radiated heat. The result was a mother, soft, warm, and tender …

Harlow also constructed wire monkey mother-substitutes.

…[W]e also designed and constructed a second mother surrogate, a surrogate in which we deliberately built less than the maximal capability for contact comfort. This surrogate mother … is made of wire-mesh, a substance entirely adequate to provide postural support and nursing capability, and she is warmed by radiant heat. Her body differs in no essential way from that of the cloth mother surrogate other than in the quality of the contact comfort which she can supply.

The babies had access to both the cloth and wire-mother substitutes:

Harlow varied which substitute could feed the babies:

This is what he found:

The babies greatly preferred the cloth mother even when the wire mother was the only one that could provide food.

He wrote:

These data make it obvious that contact comfort is a variable of overwhelming importance in the development of affectional response, whereas lactation is a variable of negligible importance. With age and opportunity to learn, subjects with the lactating wire mother showed decreasing responsiveness to her and increasing responsiveness to the nonlactating cloth mother …

Interestingly, the baby monkeys fed on formula were much healthier than their breastfed peers:

We had separated more than 60 of these animals from their mothers 6 to 12 hours after birth and suckled them on tiny bottles. The infant mortality was only a small fraction of what would have obtained had we let the monkey mothers raise their infants. Our bottle- fed babies were healthier and heavier than monkey-mother-reared infants … thanks to synthetic diets, vitamins, iron extracts, penicillin, chloromycetin, 5% glucose, and constant, tender, loving care.

What can we learn from Harlow’s monkey experiments, experiments that are at the heart of the core of Attachment Theory?

Mothers matter more than milk.

Babies become attached to whomever offers comfort, not to whomever offers milk. Breastfeeding (or formula feeding) doesn’t create the bond between mother and child, comfort does.

Why do lactivists and attachment parenting advocates ignore this central finding of Attachment Theory? It’s because lactivism isn’t about what’s good for babies; it’s about forcing women to breastfeed. Attachment parenting isn’t about what’s good for babies, either; it’s about forcing women back into the home occupied by only by traditional parenting practices. It’s at heart a religious philosophy, not the product of scientific evidence.

What does this mean for mothers?

It means that your baby needs YOU, not your breastmilk. If you want to breastfeed, go right ahead, but if you don’t want to breastfeed, there’s no evidence that formula feeding has any impact on the mother-infant bond. And if you are having trouble breastfeeding, there is no value in letting your baby go hungry or enduring pain or sacrificing your mental health in an effort to provide the supposed “extra” benefit of breastfeeding. The supposed extra benefit is trivial.

The real benefit of infant feeding comes from the mother, not from the milk.