I’m not often surprised these days, but I was surprised about this.

Christie del Castillo-Hegyi, MD and Jody Segrave-Daly RN, IBCLC of the Fed Is Best Foundation recently met with breastfeeding experts at the World Health Organization about the issue of babies starving, suffering brain injuries and dying due to insufficient breastmilk. They were told that it is “not a priority.”

Please join me in imploring them to reconsider by signing the petition, World Health Organization, please make preventing breastfeeding deaths a priority!

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Please join me in imploring them to reconsider.[/pullquote]

On Sept. 22, 2017, senior members of the Fed is Best Foundation, and guests including a neonatologist and a pediatric endocrinologist, Dr. Paul Thornton, M.D, lead author of the Pediatric Endocrine Society’s newborn hypoglycemia guidelines, met via teleconference with top officials of the WHO Breastfeeding Program: Dr. Laurence Grummer-Strawn, Ph.D., Dr. Nigel Rollins, M.D. and Dr. Wilson Were, M.D. to express their concerns about the complications from the BFHI [Baby Friendly Hospital Initiative], and to ask what, if any, monitoring, research, or public outreach the WHO has planned regarding the risks of accidental starvation.

WHO officials reported that they have not specifically studied the complications from exclusive breastfeeding and have no studies commissioned to monitor complications of the BFHI. The WHO convened a group of global infant nutrition experts last year to review and revise their guidelines, but no one on the panel raised the issue of complications as a priority for discussion.

As Kavin Senapathy reported in Forbes:

When asked 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.”

Don’t get me wrong: I’m not surprised that babies harmed by breastfeeding complications are not a priority for the WHO and the BFHI; they’ve made that very clear by their actions. I’m only surprised that they are willing to state it outright.

Sadly, breastfeeding advocates have become just like the Nestle Corporation that they so deplored. They’ve privileged the product over the outcome. In the case of Nestle, they aggressively promoted baby formula in Africa despite the fact that making formula with contaminated water harms babies. It was more important to them to promote their product than whether babies lived or died. In the case of the WHO and the BFHI, they aggressively promote breastfeeding despite the fact that up to 15% of mothers may have difficulty producing suffient breastmilk. It is more important to them to promote their product than whether babies live or die.

In response to this news, Jillian Johnson, a mother and advocate whose newborn son Landon died five years ago from complications of starvation at a BFHI hospital states, “I am appalled by the lack of concern shown by the WHO regarding such an important issue. I shared the pain of losing my son by a senseless practice and they aren’t interested in preventing it from happening to other families.”

You may remember the tragedy of Landon Johnson that his mother [pictured above] shared with the Fed Is Best Foundation, If I Had Given Him Just One Bottle, He Would Still Be Alive:

Landon cried. And cried. All the time. He cried unless he was on the breast and I began to nurse him continuously. The nurses would come in and swaddle him in warm blankets to help get him to sleep. And when I asked them why he was always on my breast, I was told it was because he was “cluster feeding.” I recalled learning all about that in the classes I had taken, and being a first time mom, I trusted my doctors and nurses to help me through this – even more so since I was pretty heavily medicated from my emergency c-section and this was my first baby…

So we took him home … not knowing that after less than 12 hours home with us, he would have gone into cardiac arrest caused by dehydration…

I am also appalled by the lack of concern shown by the WHO and the BFHI for babies harmed by breastfeeding complications. If you feel the same way, please sign the Change.org petition imploring the them to revise their guidelines to alert parents an providers to the signs of insufficient breastmilk and and how to judiciously supplement with formula to prevent both brain injuries — from hypoglycemia (low blood sugar), dehydration and severe jaundice — and deaths.

Nothing will bring back babies who have already died or reverse brain injuries that have already occured. Nothing will assuage their parents’ heartbreak. But we can hope that publicizing the signs and symptoms of insufficient breastmilk as well as the treatments will prevent similar tragedies. Both the WHO and BFHI should do everything in their power to prevent future breastfeeding injuries and deaths.

Sign the petition here!

I’ve been writing about this issue for more than a decade: the stress, shame and guilt of contemporary mothering ideology. Now it has hit the mainstream with the cover of TIME Magazine: The Goddess Myth, How a Vision of Perfect Motherhood Hurts Moms.

As Claire Howorth notes in the cover article, Motherhood Is Hard to Get Wrong. So Why Do So Many Moms Feel So Bad About Themselves?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Maternal guilt, shame and suffering is not a bug in the philosophy, it’s the ultimate purpose.[/pullquote]

…Call it the Goddess Myth, spun with a little help from basically everyone–doctors, activists, other moms. It tells us that breast is best; that if there is a choice between a vaginal birth and major surgery, you should want to push; that your body is a temple and what you put in it should be holy; that sending your baby to the hospital nursery for a few hours after giving birth is a dereliction of duty. Oh, and that you will feel–and look–radiant.

The myth impacts all moms. Because they partly reflect our ideals, hospital and public-health policy are wrapped up with it. But even the best intentions can cause harm. The consequences vary in degree, from pervasive feelings of guilt to the rare and unbearable tragedy of a mother so intent on breastfeeding that she accidentally starves her infant to death.

I spoke to Howarth for her piece and she mentioned my book Push Back: Guilt in the Age of Natural Parenting:

Luckily, An anti-shame canon is growing. Political scientist Courtney Jung’s recent book Lactivism argues that breast milk has become an industry the way formula once was, compounding the incentives and pressures that potentially hurt moms. Amy Tuteur, a former OB, wrote Push Back, a polemic against natural parenting. In Blaming Mothers, legal scholar Linda Fentiman writes that “mothers–and pregnant women–are increasingly seen as exclusively responsible for all aspects of their children’s health and well-being.”

Howarth concludes:

Motherhood in the connected era doesn’t have to be dominated by any myth. Social media can just as easily help celebrate our individual experience and create community through contrast. Moms have to stick together even as we walk our separate paths. We have to spot the templates and realize there are no templates. We have to talk about our failures and realize there are no failures.

But it isn’t an accident that the goddess myth —— natural parenting —— is pitting women against each other and causing shame and guilt. That’s what it was designed to do. Natural parenting is not about raising children; it’s about controlling women.

Specifically, it’s about re-immuring them back into the home. If you were a misogynist who felt threatened by competition from women in business, science and politics, what better way is there to marginalize women once again than to divert them into competing over who has the better vagina and breasts?

That was the conscious plan of the founders of the natural childbirth, lactivism and attachment parenting movements. Grantly Dick-Read, fabricated the racist lie that “primitive” (read black) women had painless childbirth and that white women of the “better classes” who wanted to have painless childbirth, too, simply had to withdraw from competing with men to compete with other women over who had the more “authentic” birth.

That was the conscious plan of the founders of the La Leche League, 7 devout Catholic women, who saw the promotion of breastfeeding as a way to keep mothers of young children out of the workforce and send them back home where they belonged.

Dr. William Sears, the popularizer of attachment parenting, is a religious fundamentalist who promulgated a philosophy that fetishizes physical proximity of mother and child (“baby wearing”) effectively forcing women back into the home.

Natural parenting justifies its intrusiveness into maternal choice by promoting fear in regard to infant and child health. Natural parenting advocates inflate risks of rare events to monstrous proportions or invent theoretical risks that have never been seen in real life. Using and misusing the language of science, natural parenting advocates problematize infant and child safety.

For example:

Lactivists howl that low breastfeeding rates compromise infant health despite the fact that breastfeeding rates have no correlation at all with infant health. Infant mortality rates dropped precipitously through the 20th century despite the fact that for most of that time period breastfeeding rates dropped like a rock. Indeed, the countries with the highest infant mortality rates in the world have the highest breastfeeding rates.

By promoting fear about their children’s well-being, the philosophy of natural parenting causes women to tightly regulate their behavior so it conforms with the “rules” of natural parenting and to pathologize and blame themselves when they fail in conforming to those rules. Hence the outpouring of guilt and recrimination for epidurals, C-sections, formula feeding and other deviations from natural parenting diktat.

Why has natural parenting become popular despite the fact that it imagines threats to children that don’t exist? Because it fits neatly into our cultural myths about motherhood: the motherhood is a woman’s highest calling, that suffering is integral to motherhood and that women belong in the home not in politics, business or the academy.

Natural parenting harms mothers through guilt, shame and suffering; it is critical to understand that that’s not a bug in the philosophy, it’s both a defining feature and the ultimate purpose.

They were announced with great fanfare.

In a document entitled Safe Prevention of the Primary Cesarean Delivery, The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recommended dropping the Friedman curves of labor progress and offered new standards for normally progressing labor:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Despite delaying the diagnosis of labor arrest for hours, the C-section rate didn’t fall, but the maternal and neonatal morbidity rates increased by 60% and 80% respectively.[/pullquote]

Specifically:

…[C]esarean delivery for active phase arrest in the first stage of labor should be reserved for women at or beyond 6 cm of dilation with ruptured membranes who fail to progress despite 4 hours of adequate uterine activity, or at least 6 hours of oxytocin administration with inadequate uterine activity and no cervical change.

And:

…[B]efore diagnosing arrest of labor in the second stage and if the maternal and fetal conditions permit, at least 2 hours of pushing in multiparous women and at least 3 hours of pushing in nulliparous women should be allowed. Longer durations may be appropriate on an individualized basis …

They were greeted rapturously at the time they were introduced.

Judith Lothian wrote on Science and Sensibility:

These guidelines offer great promise in lowering the cesarean rate and making labor and birth safer for mothers and babies. They also suggest an emerging respect for and understanding of women’s ability to give birth and a more hands off approach to the management of labor. Women will be allowed to have longer labors. Obstetricians will need to be patient as nature guides the process of birth. Hospitals will have to plan for longer stays in labor and delivery. And women will need to have more confidence in their ability to give birth… The prize will be safer birth and healthier mothers and babies.

Now comes word that not only do the guidelines fail to reduce the C-section rate, they increase both maternal and neonatal morbidity.

The new paper is New Labor Management Guidelines and Changes in Cesarean Delivery Patterns by Rosenbloom et al.

The authors followed the labors of nearly 8000 women that occurred at their institution from 2010 to 2014. They found:

The CD [Cesarean delivery] rate in 2010 was 15.8% and in 2014 17.7% (p-trend 0.51). In patients undergoing CD for arrest of dilation, the median cervical dilation at the time of CD was at 5.5 cm in 2010 and 6.0 cm in 2014 (p-trend 0.94). In these patients, there was an increase in the time spent at last dilation: 3.8h in 2010 to 5.2h in 2014 (p-trend 0.02)…

There were 206 CDs for arrest of descent. The median pushing time in these patients increased in multiparous patients from 1.1h in 2010 to 3.4h in 2014 (p-trend 0.009); in nulliparous patients these times were 2.7h in 2010 and 3.8h in 2014 (p-trend 0.09). There was a significant trend towards increasing adverse neonatal and maternal outcomes (p<0.001 for each). The aOR for adverse maternal outcome for 2014 compared to 2010 was 1.66 (95%CI 1.27, 2.17) … The aOR of adverse neonatal outcome in 2014 compared to 2010 was 1.80 (95%CI 1.36, 2.36).

In other words, despite delaying the diagnosis of labor arrest for hours, the C-section rate didn’t fall, but the maternal and neonatal morbidity rates increased by 60% and 80% respectively.

This is precisely what Dr. Friedman came out of retirement at age 89 to warn about in Misguided guidelines for managing labor:

Using untested guidelines for the management of labor may adversely affect women and children. Even if those guidelines were to reduce the currently excessive cesarean delivery rate, the price of that benefit is likely to be a trade-off in harm to parturients and their offspring. The nature and degree of that harm needs to be documented before considering adoption of the guidelines.

Of course, the latest study is hardly the last word on the topic. As the authors themselves point out:

A similar study from Pennsylvania examined the adoption of the new labor guidelines in nulliparous patients; researchers found a decrease in cesarean rates from 26.9% to 18.8% and the frequency of CD for arrest of dilation dropped from 7.1% to 1.1% …

But:

…[T]heir primary outcome was the CD rate among induced or augmented patients, while ours was the total CD rate. Our study also incorporated a far greater number of patients and took place over 5 years.

The bottom line is that in this study, the “hands off approach” recommended by natural childbirth advocates not only didn’t reduce the C-section rate, it actually harmed mothers and babies. That’s nothing to cheer about.

On Sunday, Secretary of State Rex Tillerson, speaking about his genitalia, declared: “I checked. I’m fully intact.”

Tillerson was responding to Senator Bob. Corker’s criticizing President Trump’s public undercutting of his Tillerson on the issue of North Korea: “You cannot publicly castrate your own Secretary of State …”

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]For a man who feels emasculated by competition from women, what better way could there be to marginalize them than natural parenting?[/pullquote]

It’s not an accident that the state of men’s genitalia has become a political issue. Trump’s favorite epithet, “little,” was first used in conjunction with Marco Rubio and most recently in regard to North Korea’s dictator. It’s also behind the derogatory claim that Trump has little hands. The charge of emasculation is Trump’s most vicious insult because it is his deepest fear. And it’s also the fear of his most ardent supporters.

In some ways, the events of the past two years seem inexplicable. Voters (though not a majority) ignored the successes of President Obama and elected his polar opposite. Where Obama is devoted to diversity and overcoming prejudice, Trump is a racist; where Obama is notably uxorious and supportive of equality for women; Trump is a thrice married sexual predator; where Obama is brilliant, Trump is a moron (as Tillerson noted); where Obama is urbane, Trump is a pig. Most importantly, where Obama was secure in his masculinity, Trump lives in desperate fear of flaccidity.

That fear lead to the irrational hatred of Hilary Clinton and the dread of a female president animating both Trump and his most ardent supporters. Instead they turned to toxic masculinity.

What is toxic masculinity?

According to Wikipedia:

Toxic masculinity is a cultural perspective held by individuals which emphasizes the ideology and importance of men maintaining a dominant, aggressive, unemotional and sexually aggressive attitude, both collectively and as individuals …

Men in the grip of toxic masculinity feel emasculated by women, by black people, by gay people and by the fanciful threat of immigrants stealing their jobs. Such fearful men preserve their sense of masculinity by flaunting misogyny, racism and homophobia. It is critical to their self esteem to put women, black people and gay people back “in their place.”

What does this have to do with natural childbirth, breastfeeding, attachment parenting and the other topics that I typically write about? Quite a bit, as it turns out. Misogyny and “pussy grabbing” are overt reflections of men’s fear of being emasculated by women’s increasing power; a far more subtle manifestation is the phenomenon of natural parenting.

In a society where women can no longer be forced to stay immured and unthreatening in the home, natural parenting is the perfect stealth method for manipulating women into believing they must stay home, in retreat from the public arena. While ostensibly promoting the wellbeing of infants and small children, natural parenting is really about weighing down mothering with so much work and so much moralizing that a “good mother” can’t possibly do anything but mother.

Grantly Dick-Read was painfully honest that he created the philosophy of natural childbirth as a way to keep women at home; only there could they find true happiness by fulfilling their biologic destiny, and then they would stop agitating for political, legal and economic equality, thereby assuaging men’s fears of impotence and emasculation

La Leche League and the lactivist movement were founded for similar reasons. Their message that breastfeeding is obligatory because Nature intended for women to breastfeed is a reflection of their belief that staying home is obligatory because God intended for women to stay home and assuage men’s fears of impotence and emasculation.

Attachment parenting purports to reflect the science of attachment, but is the exact opposite of what we know about infant attachment. The reality is that attachment parenting reflects the Bill and Martha Sears fundamentalist Christian beliefs about traditional gender roles where women are subservient to men, thereby assuaging their fears of impotence and emasculation.

Natural parenting is predicated on the notion of the man as breadwinner and the woman as nurturer. It both assumes and requires that women ought to be judged by the function of their reproductive organs instead of their intelligence, talents and character.

Natural parenting strips women of political and economic power and insists that they can be “empowered” by refusing pain relief in childbirth or breastfeeding their babies. If you were a misogynist who felt emasculated by competition from women in business, science and politics, what better way could there be to marginalize women once again than to divert them into competing over who has the better vagina and breasts?

White men are accustomed to privilege. When you’re accustomed to privilege, equality feels like oppression … or worse, it feels like impotence and emasculation. Fear of flaccidity leads inevitably to misogyny, but that misogyny does not have to be overt. Convincing women to retire from the arena to obsess about their reproductive organs and their children’s well being looks different from whining about diversity in tech or bewailing a “witch hunt” over sexual predation, but it’s just as effective in reducing men’s fears.

Our deepest assumptions often go unexamined. That’s especially true if we live in a culture that takes those same assumptions for granted. One of the central assumptions of modern, Western culture is that raising happy, healthy children requires that mothers suffer.

I suspect that this bedrock assumption goes back at least to the Book of Genesis, which sought to make sense of the agony of labor by declaring that God wanted women to suffer as punishment for Eve’s indiscretion; as a result, she and Adam were driven from the Garden of Eden. It’s analogous to the ancient Greek idea that thunder is the result of gods fighting; it’s a poor effort to explain natural phenomenona that could not be understood in the absence of science. The big difference is that no one now believes that thunder is caused by the gods, while many people still believe that suffering is integral to motherhood.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]A central assumptions of modern, Western culture is that raising happy, healthy children requires maternal suffering. [/pullquote]

What is natural childbirth, really, beyond the assumption that suffering unmedicated agony in an attempt to have a vaginal birth is “better” for babies?

Sure, you can dress it up with fancy scientific sounding rationalizations like the claims that epidurals interfere with labor and harm babies (both shown to be false) or fabricated nonsense that labor pain is necessary for mother-infant bonding (for which there is no evidence whatsoever). If you’re going to lie, why not go all the way and try to convince women that their agony is good for them? They can be “empowered” by it.

Pro-tip: If it doesn’t empower an Afghan teenager to give birth without pain relief or medical assistance, it isn’t going to empower a privileged white woman who fetishizes refusing those same things.

There’s really no limit to the trade offs that natural childbirth advocates encourage women to make. Sure, vaginal birth might lead to tears from the clitoris to the anus, might result in urinary and fecal incontinence and sexual dysfunction but, but, but the microbiome!!! But, but, but epigenetics!!! There is no ostensible benefit to a baby too theoretical or unproven that it can’t be used to convince women that they deserve to suffer.

Lactivism is exactly the same. Breastfeeding advocates are forever fabricating new “benefits” of breastfeeding from poorly designed, weak studies that offer conflicting data, riddled with confounders. No matter that all their predictions about the lives and money saved by increasing breastfeeding rates have failed to materialize despite massive increases in breastfeeding rates over the past 40 years.

In agony because it feels like someone is macerating your nipples every two hours? Exhausted because you have to pump between feeding sessions to boost your supply? Unable to treat your postpartum depression for fear that the medication will contaminate your breastmilk? So what? Mothers must suffer because formula has “risks.” Let’s ignore the fact that two entire generations of Westerners were raised on formula and during those years every possible parameter of infant health continued to improve at the same rate as before formula became popular.

You want to give your baby formula because it is more convenient for you? How dare you imagine that you have the right to work, to rest, to control your own body? Only amoral, self absorbed harridans consider their own wants and needs.

Attachment parenting is the ultimate manifestation of the belief babies need their mothers to suffer in order to be happy. Attachment parenting postulates that mothers must serve as bedraggled chew toys for babies. Mothers are counseled that they can never leave their babies’ sides even to sleep or those babies will grow up to be neurotic failures. Curiously, the rise of attachment parenting has been accompanied by a rise in psychiatric disorders among children and teens, not to mention an increase in anxiety, depression, hospitalization and suicide among young people. There’s no evidence that attachment parenting caused this rise in mental health problems, but there’s certainly no evidence that it prevented it.

Don’t get me wrong, parenting (not just mothering) requires sacrifice. Parents sacrifice money, time, convenience and indulgences in order to raise children. But it does NOT require maternal suffering. There is precisely zero evidence that women who suffer in labor have children who are happier or more successful. There’s no evidence that women who suffer to breastfeed have provided anything beyond trivial health benefits for their children. And there’s never been evidence that attachment parenting is based on anything beyond the religious prejudice and misogyny of Bill and Martha Sears, who believe that God wants women subservient to men and immured in the home.

So if suffering is not integral to raising happy, healthy children, why are natural parenting advocates exhorting women to suffer? Because one of the central unexamined assumptions of our culture is that women deserve to suffer.

We have a word for that assumption: misogyny.

It’s time to reject suffering and misogyny in parenting … and in every other sphere of life.

Sugh a tragic, senseless waste of life!

From The Sun:

Rhianne Statom-Barnett, 30, was worried the prescription-only medication might affect her three-month-old son George through the transfer of baby milk.

Her mother explains what happened when Rhianne developed a severe ear infection:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Cause of death: the culture of maternal self-neglect that is at the heart of breastfeeding promotion.[/pullquote]

Her mother Beverly, 55, told the hearing her daughter booked a GP appointment where she compared the pain to giving birth.

Beverly, a nurse, said: “We looked at her ear and it had blood and fluid coming out of it.

“She said she had a severe headache and her ear was hurting a lot. She said it was worse than labour pains.”

Three days later she found her daughter unconscious in her bed after George started at crying at 5am.

Beverly said: “She had vomited and when I called out her name she didn’t respond we called an ambulance.

“At hospital the senior doctor came out and told us that Rhianne was effectively brain dead. It was heartbreaking.”

Breastfeeding — and the culture that surrounds it — killed this mother as surely as if a lactivist had taken a gun and shot her through the head.

Here’s what I’d like to know:

Where did this young mother get the idea that antibiotics would be harmful to a breastfeeding child?

Why wasn’t her doctor able to reassure her that most antibiotics are safe during breastfeeding and prescribe an antibiotic that was known to be safe?

How did Rhianne come to believe that suffering in agony (describing the pain as worse than labor) was necessary to protect her baby?

Who encouraged Rhianne to risk her hearing, health and life as less important than breastfeeding her baby? Did she reach out to a Facebook group that supported her decision to refuse antibiotics? Did she consult a lactation professional who told her that she must avoid medication of any kind regardless of the risk to her?

Of course determining the answers to these questions doesn’t change the bottom line: a young mother is dead because of breastfeeding.

No doubt, the lactivists will be parachuting in to tell me that I mustn’t blame breastfeeding. They will insist that it wasn’t breastfeeding that killed this mother, it was the bacteria in her ear.

Yes, the bacteria were the proximate cause, spreading from her ear to the bones of her skull and then to her brain, but the real cause was the veneration of maternal self-neglect that is at the heart of breastfeeding promotion and, indeed, all natural mothering.

The three ideologies that sail under the natural parenting flag — natural childbirth, breastfeeding and attachment parenting — are promoted as both recapitulating mothering in nature and better for babies. Neither is true. All were created explicitly as anti-feminist projects designed to force women back into the home.

For example, La Leche League, the prime mover within the breastfeeding industry, was founded by a group of devout Catholic women who were deeply concerned that women with small children were working outside the home. They reasoned that Mary, mother of Jesus, would never have worked and that promoting breastfeeding would lead women to emulate Mary and to give up their jobs.

All three philosophies share another thing in common: the belief that the women’s needs are irrelevant, rendered invisible by the purported needs of babies. The breastfeeding industry treats women like cows: milk dispensers and nothing more.

A mother’s pain is irrelevant. For lactivists, just because a mother has cracked and bleeding nipples is no excuse for her to avoid breastfeeding.

Breastfeeding difficulties are irrelevant. Regardless of the difficulty (poor latch, flat nipples, poor suck, insufficient breastmilk) and regardless of the severity of the difficulty the lactivist prescription is always the same: “Breastfeed harder.”

A mother’s need for sleep is irrelevant. She is supposed to dispense breastmilk 24/7/365.

A mother’s need to control her own body is irrelevant. If breastfeeding makes her psychologically uncomfortable, she’s supposed to get over it.

A mother’s mental health is irrelevant. Lactivists are much more concerned with whether treatments for postpartum depression are compatible with breastfeeding than with whether they are the best possible treatment for the mother’s psychological condition. The mother must continue dispensing breastmilk even if she is inexorably approaching psychological collapse.

Maternal self-neglect is the order of the day. It’s hardly surprising then that a breastfeeding mother risked her own life, refusing antibiotics and enduring excruciating pain, in order to ensure that her breastmilk was pristine.

There is something very, very wrong when breastfeeding is promoted so aggressively (despite trivial benefits) that women are encouraged to neglect themselves to the extent that they end up dead.

A mother’s health and sanity is infinitely more important to her child than any amount of breastmilk.

Heeeee’s baaaaack!

Michel Odent is back with another of his wacky, entirely fabricated theories about childbirth.

Michel Odent has moved from being the benign natural-birth pioneer to a doomsayer predicting that caesarean sections will increase autism spectrum disorders and change humanity on an evolutionary level.

And the doom he foretells?

The Birth of Homo, The Marine Chimpanzee theorises that the way babies are delivered could be one cause of increased numbers of developmental disorders, psychological problems and addictive behaviours. He has interpreted epidemiological studies that show that a high number of children born by caesarean section or induction go on to be diagnosed with an autism spectrum disorder in support of his theories.

I beg to differ, Odent hasn’t “moved.” Natural childbirth has always been about preaching doom for those who give birth using technology.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Natural childbirth has always been about old white men insisting that women must suffer agonizing pain or “bad things” will happen.[/pullquote]

It’s always been about old white men, mansplainin’ childbirth to us poor, benighted womenfolk, insisting that we must suffer agonizing pain or “bad things” will happen.

And it’s always about controlling women and their bodies.

It started with opposition to the use of chloroform in childbirth. Both religious leaders and doctors opposed the use of pain relief as a violation of God’s wishes that women suffer in childbirth to atone for Eve’s original sin. The only thing that has changed more than 150 years later is the nature of the “bad things.”

The father of childbirth mansplainin’ was Grantly Dick-Read, a eugenicist, who freely admitted that his claims were intended to get white women of the “better” classes back into the kitchen and pregnant, instead of agitating for political and economic rights.

Odent is also a eugenicist. He claims:

One effect of modern obstetrics is to neutralise the laws of natural selection – the laws that foiled us all [in the past]. We have neutralised those laws. It means that at the beginning of the 20th century, a woman who could not give birth naturally would die, whereas the one in the village who could give birth easily would have 12 children. Today, the number of children one has depends on other factors than the physical capacity to give birth.

Like most eugenicists, Odent betrays a fundamental misunderstanding about evolution. Natural selection does not lead to survival of the perfect, but rather survival of the fittest. Fitness changes when the environment changes. Those who are best able to exploit the environment in which they live are the fittest. In a highly technological society like ours, the ability to exploit technology is a key to fitness.

The graph below vividly illustrates the truth of this:

The acquisition of technology fueled explosive population growth, the ultimate measure of evolutionary success. The use of technology does not “weaken” the human race, it strengthens it.

This is not Odent’s made up nonsense. That includes his famous lie that childbirth pain is necessary for maternal-infant bonding and his fear of attending the births of his own children:

As it happens, at the exact moment our son arrived in the world, the midwife was on her way down the street and I, having made my excuses realising he was about to be born, was fiddling with the thermostat on the central heating boiler downstairs.

My partner did not know it, but I had given her the exceptionally rare, but ideal situation in which to give birth: she felt secure, she knew the midwife was minutes away and I was downstairs, yet she had complete privacy and no one was watching her.

It is easy for to understand that Odent’s “theory” of fathers at birth is nothing more than a projection of his own anxieties. His other theories are no different. They reflect the standard misogyny of old white mansplainers: women are meant to suffer, men must tell them how to give birth, and prejudice can be dressed up as the “science” of eugenics, masquerading as concern for the future of the human race.

According to Odent:

…So if we say that everyone can have a baby, from a short-term perspective, that is positive. But I am not talking about the short term, I am thinking of the future of mankind. There have been human beings on this planet for millions of years and how long can humanity survive now? It’s probably a negligible number of years in comparison with the past.”

The truth is exactly the opposite of Odent’s eugenics. When technology allows everyone to have a baby, and technology protects every baby’s health and brain function, the result is not an epidemic of feeblemindness and genetic weakness, but vitality, longetivity and accomplishment such as we have never known.

A new paper, Resisting Guilt: Mothers’ Breastfeeding Intentions and Formula Use by Holcomb, explores what happens when breastfeeding is represented as a “choice” that is an unalloyed good for all babies and all mothers.

Although lactivists insist that such a claim is the inevitable result of scientific research, in truth the claim is a cultural construct. The reality is that breastfeeding is often not a matter of choice, and is not an unalloyed good for either mothers or babies. Many mothers live in that intersection between reality and cultural imperative, an intersection that is saturated with guilt. Holcomb seeks to understand how women manage that guilt.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breastfeeding is often not a matter of choice, and is not an unalloyed good for either mothers or babies. [/pullquote]

The paper offers an excellent exposition of the scientific evidence and the cultural dominance of a narrative that was created by and for privileged, mostly white women to suit themselves.

Lactivists encapsulated their views in the phrase “Breast is Best,” but:

It is important to note, however, that the research upon which this perception of “breast is best” is based has been critiqued… Some researchers argue that the positive benefits are often overstated; that research studies indicating a lack of significance are downplayed; and that broader family characteristics, such as socioeconomic status, have more of an impact on health outcomes than does breastfeeding… [M]any of the benefits of breastfeeding become statistically insignificant in within-family models that look at differences between siblings where one child was breastfed and the other was not… Despite these critiques, the discourse of “breast is best” maintains a powerful status.

Moreover, breastfeeding rates are closely correlated with socioeconomic factors:

…[P]rior research on breastfeeding indicates that age, level of education, income, race, and ethnicity are correlated with breastfeeding behaviors… Some scholars point to structural barriers, such as maternity leave policies, inflexible work, inadequate healthcare, and complex historical factors as some of the reasons behind these differences.

In other words:

Hegemonic understandings of good mothering include breastfeeding, but it is critical to keep in mind the raced and classed nature of those understandings.

How do women deal with the resulting guilt? They do this by resisting the fundamental claims of lactivism.

Breastfeeding is often NOT a choice.

..[W]omen in this study often found things beyond their control. Even though they knew the benefits of breastfeeding and tried to find medical staff supportive of breastfeeding, they experienced aspects of the process that were outside of their control—they had their own medical emergencies, formula was used without their consent, and those with medical authority recommended using formula. These mothers did not discuss their use of formula in terms of regret, guilt, or failure but rather as something that happened, at the advice of medical staff, despite their best laid plans.

In addition, breastfeeding is not a choice when women up to 15% of first time mothers are unable to produce enough breastmilk to fully nourish an infant. Moreover, some infants have difficulty obtaining milk from the breast because of poor sucking ability or structural issues (tongue-tie).

It isn’t merely physical factors that make breastfeeding difficult or impossible; socioeconomic factors also contribute.

…[B]reastfeeding occurs within a complex social context that can include working or going to school. When social context is included in discussions of breastfeeding, breastfeeding success becomes more than an individual decision and individual knowledge, incorporating factors such as work, school, racial and ethnic traditions, and historical factors.

Breastfeeding is not good for every baby.

Infant health is put at risk if mothers are not able to produce enough breastmilk. Babies suffer terribly from hunger, screaming for hours on end. Without formula supplementation some babies will develop dehydration, hypoglycemia, severe jaundice, failure to thrive, brain damage; some babies will even die. Contrary to the claims of lactivists, these harmful results are, unfortunately, not rare.

Breastfeeding is not good for every mother.

In the cosmology of lactivism, mothers are reduced to milk dispensers. But mothers are people and they matter. There is nothing beneficial to mothers from pain, frustration, exhaustion and postpartum depression.

…[M]others found the use of formula to be acceptable in that it allowed them to alleviate stress associated with continued breastfeeding or provided them the opportunity to focus on other aspects of well-being. Using formula allowed mothers to focus on other things, such as making homemade baby food, being present at work, and nurturing relationships with partners. Their children seemed to transition to formula smoothly, without upset intestinal tracts or lengthy episodes of crying. Given the stress and anxiety that they experienced during breastfeeding, and the ease of using formula, the mothers decided that using formula enhanced the greater good and that the method of nutritional delivery was not the only factor contributing to family well-being.

Combination feeding or exclusive formula feeding are often best for individual babies, individual mothers and individual families.

The ultimate irony, of course, is that strenuous efforts to increase breastfeeding rates have been ineffective. That’s just what you would expect when breastfeeding is not simply a choice, and is often experienced by babies are mothers as harmful, not healthful.

As Holcomb notes:

The women in this project—who were mostly white, highly educated, with higher earnings and who wanted to breastfeed—should have been “successful” breast feeders. It is particularly telling that even with this sample demographic, nine mothers (40%) used formula within the first week. Only six mothers (27%) breastfed for an entire year without using formula. Eight mothers (36%) had completely stopped breastfeeding by six months. The challenges they experienced are worth exploring in more detail, as they were mothers who wanted to breastfeed and who, demographically speaking, were expected to breastfeed for longer periods.

This is a small study and ought to be repeated on a larger scale before we can draw firm conclusions. But it does highlight an important fact:

…Breastfeeding is a process that unfolds over time (often in response to unexpected challenges along the way) and occurs within a context in which many other factors are significant. Future discussions of breastfeeding need to move beyond a focus on individual mothers and toward a recognition of how various aspects of social context impact breastfeeding experiences.

In other words, it is inaccurate to frame breastfeeding as a choice or best for either babies or mothers. The incontrovertible truth is that Fed Is Best. And the privileged, white women (such as myself) who have breastfed successfully are just lucky, not superior.

I am not making this up.

STAT News reports:

Children of women who ate little or no meat while pregnant are more likely to abuse alcohol, tobacco, and marijuana at age 15 than are children of mothers who did eat meat.

That’s the conclusion from a new study Meat Consumption During Pregnancy and Substance Misuse Among Adolescent Offspring: Stratification of TCN2 Genetic Variants published in Alcoholism Clinical and Experimental Research.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Until a result is reproduced, it ought to be viewed as interesting, but speculative and unproven.[/pullquote]

How was the study performed? According to STAT News:

Researchers analyzed data from 5,109 women and their children in a long-running study in England called ALSPAC (the Avon Longitudinal Study of Parents and Children), which has gathered years of data on what women did while pregnant and their children’s health. The less meat the women ate while pregnant, the more their children’s risk of drinking, smoking, or using marijuana as 15-year olds, Dr. Joseph Hibbeln of the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health and his colleagues reported on Wednesday in Alcoholism: Clinical and Experimental Research. (They were funded by the U.S. and U.K. governments and a charity, not meat producers.)

Roughly 10 percent of the 15-year-olds smoked at least weekly, drank enough to have behavioral problems, or used marijuana “moderately.” But teens of meatless moms were 75 percent more likely to have alcohol-related problems, 85 percent more likely to smoke, and 2.7 times as likely to use marijuana compared to teens of mothers who’d eaten meat while pregnant.

Children of pregnant vegetarians are more likely to abuse drugs and alcohol.

Ironic, isn’t it, that a diet thought by its practitioners to be healthier is actually harmful to developing babies?

Ironic … and almost certainly untrue.

This research represents a cautionary tale, not about the risks of vegetarianism, but about the risks of p-hacking, a practice beloved of some scientists, particularly those in the field of breastfeeding research.

P-hacking often occurs in the analysis of large data sets. It refers to the value “p” used to determine statistical significance. A difference between two groups is only meaningful if it is statistically significant, expressed as the chance that the findings are due to chance. For example, a p value less than 0.001 means that there is a less than a 0.1% chance that an observed finding is due to chance and a greater than 99% chance that it represents a real difference.

Researchers look for statistically significant differences between two groups. Then they announce them as “findings” without acknowledging that any large dataset looking at multiple outcomes is bound to have random statistically significant differences that are coincidental and don’t represent real outcomes. Indeed, by definition using a p value of less than 0.001 means that almost 0.1% of the differences that appears to be statistically significant are actually due to chance and don’t represent a real finding at all.

When looking at studies of a few variables, a p value of 0.001 means that a statistically significant results is almost certainly a real result. However, mining of large datasets may involve thousands of variables. For example, in mining a dataset of 10,000 possible variables, we would expect that 0.1% — 10 statistically significant results — are, by definition, actually due to chance, and therefore, not real.

How can we guard against p-hacking? The most important way is to recognize that it is always a possibility when analyzing large datasets; in other words, it is wrong to conclude that every statistically significant result in such an analysis is a real result.

In addition, there are a number of additional statistical tests that can give greater insight into whether a result is real or just a statistical artifact.

The ultimate insurance that a result is real and not an effect of p-hacking is a basic principle of all research: reproducibility. Do other data sets produce the same results? Unless and until the finding is reproduced, there is no reason to believe that the results are real.

Therefore, we should not be rushing to counsel pregnant women that vegetarianism leads to substance abuse among offspring. It almost certainly does not. The finding is most likely spurious, just an artifact of the statistical analysis.

This cautionary tale has implications far beyond this study, most especially in breastfeeding research. Many of the purported claims about the benefits of breastfeeding are also based on mining of large datasets. Such studies by definition will produce spurious statistically significant relationships. When such a “benefit” is discovered in breastfeeding research, it should be greeted with the exact same skepticism that ought to greet this study.

A good rule of thumb is this: Until a result is reproduced, it ought to be viewed as interesting, but speculative and  unproven.

The sky is falling! The sky is falling!

That’s the impression you might get from an article in today’s Guardian, ‘A third of people get major surgery to be born’: why are C-sections routine in the US?

Caesareans have transformed from life-saving intervention into risky procedure performed for one in three births – and often geography is the deciding factor.

Yet the scientific evidence shows that the demonization of C-sections is based on ideology and contradicted by data.

Ideology oozes from nearly every quote in the piece.

“We are quite worried when the C-section rate goes above 30%, as it is in the United States,” said Dr Flavia Bustreo, the assistant director general for family, women’s and children’s health at the World Health Organization…

A C-section rate of 10% to 15% is “natural”, she said. “Above 15%, you don’t have additional benefits, and you have the risks, and you have the unnecessary health costs.”

There is no such thing as a natural C-section rate. Perhaps Dr. Bustreo means that a C-section rate of 10-15% is “optimal,” but that’s not what the scientific evidence shows.

In fact, some experts believe this rise in caesareans is one of the many intertwining factors contributing to crisis rates of maternal mortality, or death, and morbidity – defined as significant injury related to a pregnancy – which are increasing in the US even as they fall in other first-world countries.

“It’s certainly one of the downstream consequences” of performing avoidable C-sections, said Jill Arnold, who runs a website, The Unnecesarean, that tracks individual hospitals’ C-section rates …

Jill Arnold is not an expert. She’s a lay person and an ideologue. And she has no data that shows that C-section increase maternal mortality because there isn’t any.

“A third of people get major surgery to be born,” said Dr Neel Shah, a research physician at Beth Israel Deaconess Medical Center who works on ways to reduce avoidable C-sections.

As someone who had a 16% C-section rate when I practiced, I find myself mystified by a C-section rate of over 30%, but that, in itself, is not a reason to demonize C-sections. A third of the people in the US need glasses for nearsightedness yet we don’t conclude that glasses are over prescribed.

“It is very, very clear to me the connection between the number of C-sections and mortality and morbidity,” said Dr Shah.

I don’t know how it could be clear to him that C-sections increase maternal mortality since his OWN data show precisely the opposite.

Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality was published in JAMA in 2015. The authors, including Dr. Shah, concluded:

The optimal cesarean delivery rate in relation to maternal and neonatal mortality was approximately 19 cesarean deliveries per 100 live births.

They graphed their data:

These graphs show that C-section rate below 19% lead to preventable maternal and neonatal deaths. In other words, they show that the WHO “optimal” rate, far from being optimal, is actually deadly.

They also show that C-section rates above 19% are NOT harmful. There appears to be NO increased risk of either maternal or neonatal mortality for rates as high as 55%.

US maternal mortality statistics show that most of the leading causes of maternal death have nothing to do with C-sections.

The most important message in this graph is that fully 41% of US maternal deaths are caused by cardiovascular (including cardiomyopathy) and non cardiovascular diseases. And that reflects the fact that pregnant women are now older, more obese and suffering from more chronic diseases than ever before. There’s no evidence that a high C-section rate contributes to maternal mortality.

Indeed, Gene DeClercq, a professor at the BU School of Health echoes my view:

… Declercq, who notes he is “no fan of unnecessary C-sections”, says the bigger drivers of maternal mortality probably include factors like the opioid crisis and the fact that many new mothers are dropped from Medicaid, the government-run health program, shortly after they give birth.

Just addressing the C-section rate alone won’t reduce the maternal mortality rate. Other developed countries have C-section rates that are as high as the United States’. A 2012 international comparison found that the C-section rate was 21.8% in Norway and 24.4% in the UK but 31.7% in Germany and 38.8% in Canada.

Despite the claims of C-section alarmists, the sky is not falling.

But even if it were, wailing and gnashing of teeth, the preferred response of those who demonize C-sections, would not accomplish anything. That’s because the driver of C-section rates is uncertainty. We know that lack of oxygen during labor, either from placental insufficiency, trapped head during a breech birth or severe shoulder dystocia can lead to permanent brain damage and death of babies. Unfortunately, we don’t have an accurate way of determining IN ADVANCE which babies will be injured during birth.

We are forced to resort to crude methods like measuring the baby’s heart rate to determine if it is at risk, and therefore are forced to perform C-sections that turn out to be unnecessary in retrospect. We know that some babies will die during breech birth because their heads will get trapped but we have no way of predicting in advance which babies will get stuck and therefore we recommend routine C-section for breech even though we know that nearly all of those C-sections are unnecessary. We know that some babies, particularly large babies, will suffer serious complications from shoulder dystocia, up to and including death, but we don’t know how to determine which babies will suffer shoulder dystocia so we are forced to recommend C-section in many cases where it is unnecessary.

Natural childbirth advocates like to pretend that the solution to imperfect technology is no technology. Since electronic fetal heart rate monitoring has a high false positive rate, we should just stop using it. Since most breech babies will fit, we should just stop doing C-sections for breech. Since most big babies won’t be harmed by shoulder dystocia, we should simply stop worrying about it.

But the solution to imperfect technology is not forgoing technology; it is improving technology. We need to spend tens of millions of dollars (or more) perfecting a way to determine fetal oxygen levels during labor. We need to spend tens of millions of dollars (or more) perfecting a way to determine whether a specific baby in a specific position will fit through a specific pelvis. When we create such technologies, the C-section rate will drop precipitously because we learn in advance which C-sections are unnecessary and stop doing them.

Wailing about the C-section rate accomplishes absolutely nothing. Crying “the sky is falling” does not prevent the sky from falling; it’s even more irresponsible when the sky is not falling at all.