Imagine reading about a baby desperately injured after being ejected through the windshield when her mother’s car was hit. Imagine that the mother had failed to buckle the child into a car seat because she didn’t “believe in them” for short trips like the one she was taking to the grocery store. Now imagine that the mother insisted that doctors told her her baby’s serious brain injury had nothing to do with choosing to forgo a car seat.

Yeah, I wouldn’t believe her either.

That’s the reaction I have to the latest story of a child grievously injured by homebirth. I don’t have to look for these stories; as homebirth has become more popular, they’re all over various  health communication and crowd funding sites (when parents are trying to raise money to cover hospital expenses or funeral expenses or both).

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]If the mother had given birth in a hospital instead of at home, the baby almost certainly would not have sustained a devastating brain injury.[/pullquote]

This mother’s chief impulse seems to be to avoid accountability.* On the CaringBridge site she writes:

Due to several factors involved at the time of her birth (but not related to the birth itself), M was born not breathing and unresponsive.

She reiterates the same claim when telling the birth story on the “Awesome” HBAC [Homebirth after Cesarean] Facebook group:

Finally going to share my story, but before I do I must make it known that doctors have all agreed that baby’s birth in and of itself played no part in the trauma that followed.

That’s absurd.

Before we delve into what happened, let’s review how giving birth outside of a hospital could be dangerous for a baby:

• The baby might be deprived of oxygen during labor.
• The baby might need an expert resuscitation with intubation immediately after birth.
• The baby might have inhaled meconium.
• The baby might be in a dangerous position like breech.
• The baby might become infected with Group B Strep, a bacteria that is particularly deadly for newborns.

What happened in this case? Everything listed above!

The mother ruptured her membranes at 2:20 AM.

At about 2:20 PM, the mother was having contractions every 6-7 minutes and noted light meconium.

At 5:30 PM, the mother noted moderate meconium.

At 8:30 PM, the midwife arrived.

At 10:30 PM, the midwife performed an exam and discovered … the baby was breech!

As 1 AM approached:

…Baby’s heart rate remained stead and strong, but meconium was super thick (as is typical with breechlings, so we had no worries… Then the strong pressure of head coming and the sudden relief of it passing thru. I did it! Another breech baby …2hba2c!

The mother is so proud of her “accomplishment,” but what about the baby?

That’s when things took a serious turn for the worst.

The baby was born unresponsive and not breathing. In other words, as in most homebirth disasters, a nearly dead baby dropped into the hands of a totally clueless midwife.

Midwife suctioned, started CPR and oxygen and best friend called 911. Midwife continued to let the cord pulse while doing those things … when the ambulance arrived they told her to do what she needs to, clamp the cord, and pass baby off. She milked every last drop of blood from that cord that she possibly could into my baby (I firmly believe that is what saved baby’s life). Cut the cord, passed baby to EMT, he ran out the door with my baby and husband, and I and my teen daughter (who had been there the entire labor and delivery with me) collapsed on the floor sobbing…

The mother noted:

Doctors feel like it was a mixture of meconium aspiration and group b strep hitting super hard that made M not breathe/repond at birth. She was without appropriate oxygen for 10 minutes.

Of course the mother had declined testing for Group B strep before birth.

The baby was born a little over 3 weeks ago. What’s her prognosis now?

… they still can’t be certain that she won’t have issues such as low muscle tone, learning delays, and they don’t know if/when she will get suck/swallow/gag.

She’s having a gastrostomy tube placed because she will be unable to eat by mouth any time soon.

Obviously this entire disaster, and the horrible brain injury that the baby suffered, are entirely due to the decision to have a homebirth. The baby was oxygen deprived during labor, aspirated meconium, and was infected by Group B strep. All of these things could have been prevented if the mother had had an elective repeat C-section.

Did any doctors really say “that baby’s birth in and of itself played no part in the trauma that followed”? I doubt it. I suspect that what they said was that the actually delivery of the breech baby was not the cause of the problems since it wasn’t. It was the undiagnosed fetal distress, meconium aspiration, Group B strep infection, and inability to provide immediate expert resuscitation that led to the baby’s brain damage … all things that could have and almost certainly would have been avoided in a hospital. If the mother had been more concerned about the baby’s health than about her “achievement,” and consented to an elective C-section, the baby would almost certainly be perfectly healthy today.

Remember the thought experiment of the baby ejected through a windshield because her mother failed to put her in a car seat? That mother could claim that it wasn’t failure to use a car seat that caused her baby’s injury; it was the fact that her baby went head first onto the pavement after being ejected through the windshield. I wouldn’t be impressed with that claim either. In both cases a baby’s brain damage is the direct result of a mother’s negligent choice … no matter how desperate this mother is to pretend otherwise.

 

*Edited to correct a very serious error on my part: CaringBridge sites are not fundraising sites. The mother is NOT try to solicit money. I regret my mistake.

 

If you want to understand the state of breastfeeding promotion in the US today, there’s no better place to start than the vast gulf between lactivists’ (“Breast Is Best”) fears and nurturists’ (“Fed Is Best”) fears.

Lactivists fear that breastfeeding won’t be supported; nurturists fear that babies won’t be supported.

There is something very, very wrong about valuing a process more than an outcome. Sure lactivists insist that breastfeeding promotes optimal outcomes, but the outcomes themselves show that this isn’t true.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactivists fear being shamed for public breastfeeding; Fed Is Best advocates fear their babies’ deaths![/pullquote]

Lactivists fear that information about risks will discourage breastfeeding; nurturists fear that suppressing information about risks will discourage safety.

Lactivists fear that hypoglycemic, jaundiced or dehydrated infants infants might get formula; nurturists fear that hypoglycemic, jaundiced or dehydrated infants might get brain injuries.

Lactivists fear breastfeeding won’t be normalized; nurturists fear their babies won’t be normal.

Lactivists fear being shamed for public breastfeeding; nurturists fear their babies’ deaths.

That’s right; lactivism is literally killing babies. And it’s doing so in a variety of ways:

• Refusal to acknowledge that insufficient breastmilk is common, not rare
• Refusal to supplement babies who are hypoglycemic, severely jaundiced and dehydrated
• Promoting unsafe sleeping practices by leaving babies in bed with mothers who are exhausted, sedated and surrounded by soft bedding
• Closing newborn nurseries thereby preventing exhausted, sedated mothers from getting the sleep they need

We’ve all heard about baby Landon Johnson who had a cardiopulmonary arrest due to dehydration less than 12 hours after being sent home from the hospital where his mother was repeatedly assured by lactation consultants that he was getting enough breastmilk.

Now comes word of another perverse and heartbreaking tragedy. A mother is suing an Oregon hospital because her newborn suffocated to death in her hospital bed.

According to the Oregonian, Mom who accidentally suffocated newborn in hospital bed sues for $8.6 million:

A new mother who accidentally smothered her 4-day-old baby in a hospital bed has filed an $8.6 million lawsuit against Portland Adventist Medical Center.

Monica Thompson faults the Southeast Portland hospital for putting her newborn, Jacob, in bed with her in middle of the night so she could breastfeed him while she was unsupervised and heavily medicated with painkillers and sleep aids.

Thompson dozed off, then awoke to find that Jacob wasn’t breathing on Aug. 6, 2012, according to the lawsuit filed last week in Multnomah County Circuit Court.

Jacob suffered catastrophic brain damage, and his parents removed him from life support six days later after doctors told them that his comatose state was irreversible.

It’s an unspeakable tragedy because a new mother lost her healthy firstborn child to a cause that was easily preventable; it’s perverse because Jacob died as the result of the hospital’s efforts to meet the requirements of the Baby Friendly Hospital Iniatiative (BFHI), a program to promote breastfeeding because of its purported health benefits.

It really ought to be called the Baby Deadly Hospital Iniative because its major tenets are incompatible with safe infant care. These include censoring healthcare providers so they cannot provide accurate information about the risks of breastfeeding; banning formula supplementation; and closing well baby nurseries. The BFHI also bans pacifiers despite copious evidence that they reduce the risk of sudden infant death syndrome (SIDS).

Breastfeeding promotion has been causing so many injuries and deaths that the American Academy of Pediatrics has published several papers on these tragedies. The latest evidence includes:

• The revised United States Preventive Services Task Force (USPSTF) guidelines
• Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms
• Unintended Consequences of Current Breastfeeding Initiatives

Together these papers show that the BFHI doesn’t increase breastfeeding rates, ignores the scientific evidence on pacifiers, formula supplementation, and Sudden Infant Death Syndrome (SIDS) and leads to preventable infant injuries deaths when babies fall from or get smothered in their mothers’ hospital beds.

The bottom line is that the fears of lactivists are incommensurate with the fears of Fed Is Best advocates.

Lactivists are primarily concerned with their feelings — being able to breastfeed in public without censure, getting support for breastfeeding difficulties, improving their self esteem by feeling they are doing something important for their babies. Don’t get me wrong; those are fine goals and I strongly advocate for lactation services for those who wish to breastfeed and the right for women to breastfeed whenever and wherever their babies get hungry, BUT these fears pale into insignificance next to women’s fears that their babies will die due to insufficient breastmilk, smothering and falling from hospital beds.

It’s long past time to abolish the Baby Friendly Hospital Initiative. There is precious little evidence that breastfeeding saves the lives of term babies and a growing body of evidence that we are breastfeeding babies to death instead.

Dear Ms. Williams,

I was shocked to read that you — a feminist icon — have fallen prey to sexism.

Speaking about the impending birth of your first child, you told Herald Sun’s Stellar:

I am about to be a real woman now, you know? It’s going to be something incredibly impressive to go through.

Of course, the backlash has been swift and predictable, pointing out that many women don’t want or can’t have children and they are real women, too.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Sadly, you are promoting the sexist view that women are only “real” and valuable if they are using their reproductive organs.[/pullquote]

I suspect that you know that and never meant to imply otherwise, but the real problem with your statement is not that it is disrespectful to childless women (though it is). The real problem is that it is deeply retrograde and anti-feminist.

For most of human history, women were reduced to their reproductive organs — breasts, uterus and vagina. Their brains, their talents and the contents of their characters were deemed irrelevant or worse: unwomanly. Women were expected to seek fulfillment in mothering; until that day they were expected to keep themselves busy with “womanly arts” like needlework. Intellectual efforts, artistic endeavors and, obviously, physical competition in athletic pursuits weren’t merely off limits; they were considered “mannish.”

By implying that you aren’t yet a real woman, despite being a powerful, talented, brilliant and obviously womanly woman, you are reverting to the sexist view that women are only “real” and valuable if they are using their reproductive organs. It is an insidious form of sexism, but one that has become increasingly popular since the advent of the legal, political and economic emancipation of women. It is insisidous because it dresses up sexism as praise; but it is no less sexist than judging women by the size of their breasts instead of the size of their accomplishments.

As someone who has given birth to four children and raised them to adulthood I feel qualified to tell you what giving birth will and won’t do for you.

Childbirth WILL make you a mother.

Here’s a few other things childbirth will make you:

A woman with a torn vagina, leaking from just about every orifice, in pain and hoping that none of the changes are permanent. No glamor here!

It is no more impressive than being able to breathe, digest food or walk; pretty much any woman can do it. In contrast, no one can play tennis like you can.

It’s not empowering. Here’s a little tip: If it doesn’t empower a 15 year old Afghan girl giving birth in a hut in agony and at high risk of death due to lack of medical care, it’s not going to empower you.

It’s a process, not an outcome and it is the outcome of childbirth — a new, unique human being — that will change your life in ways that you haven’t even dreamed about.

Until you have a child, you have no idea what the love of a mother for her child really means. You think you are fierce now; wait until someone poses a threat to your child; you’d battle a wild animal with your bare hands and no hesitation.

Until you have a child, you have no idea what the fear of a mother for her child’s wellbeing really means. I guarantee you will obsessively check your sleeping child to be sure that he or she is still breathing. Even the idea of losing that child will be shattering and unfathomable.

Until you have a child, you have no idea what mothers are willing to sacrifice to improve their children’s lives; you have no idea how much more painful your child’s disappointments will be than yours ever were or how sweet your children’s smallest accomplishments will be even compared to your greatest accomplishments.

Until you have a child, you have no idea what unselfish love means. Finding out will be one of the greatest joys of your life.

Being a woman makes it possible to have children, but it’s hardly the only way. Don’t imagine that mothers who adopt are lesser women because they didn’t give birth. Honestly, one thing has nothing to do with another beyond basic biology and even then you have it exactly backwards; being a woman makes it possible to give birth; giving birth doesn’t make it possible to be a woman.

In truth, childbirth will make you something you have never been before, a mother; but you’ve been a real woman all along.

This post is for the apologists parachuting in to my blog and Facebook page attempting to excuse their role in a baby’s death.

Yesterday I wrote about the Facebook group Ten Month Mamas who cheered a woman as she refused to seek care for an extremely postdates pregnancy, 44 weeks by her reckoning. As complication piled on complication — prolonged ruptured membranes, meconium, transverse lie — they kept cheering, right up until the moment that they learned the baby was dead.

Had the mother successfully delivered a live baby, they would have patted themselves and each other on the back for offering the support that got her to her goal. Yet when the mother delivered a dead baby, they immediately began absolving themselves of responsibility and expressing their anger toward me for exposing them.

Here are a few choice examples of their prose:

Sadie Canning Dossor: How dare you post this! This is someone’s life you’re pontificating on and she chose to share it with a specific group and not you’re pathetic negative and Ill informed group. You are the worst kind of person for posting such confidential and sensitive information to point score. I’m not even gonna argue the issue of pregnancy time frames because each case is different, though I will say I went to 43 weeks with both mine, had lovely home and hospital births and almost no intervention.

You and your idiotic followers are full of judgement hate and ignorance and you clearly feel the need to spread this tripe. Well good luck to you, you utter bint.

And this:

Aliki Doula Livanis: This is so stupid… the whole way you go about doing things… If you didn’t bully admins in groups nor the moms who have just lost life, I would actually have some respect for you. Hell, 44 weeks plus is a far stretch for me too. I was born at 43 weeks after a medical induction, without an epidural. Maybe that’s why my mom just had me? But it was safe after having constant NST’s, or so she said. If you ended up bullying her if she had lost me, would it have changed anything? My point is, you’re not really winning… if you did what you do with dignity and grace some of us “hippies” might even hear what you’re saying. But with all this screaming and shaming, all we see is a lonely old hag who lost her medical licence for who knows what reason… who also had traumatic hospital births and doesn’t talk about it… and is bitter now shames others who choose a more graceful birth. Just a thought.

And this, which I confess I don’t really understand:

Michelle Bromley: Ms T, please go and get some help. It’s quite obvious that so need to do some serious debriefing.
You are dangerous.
These groups help and support so many. People do not advocate harm to mothers and babies. I’ve seen many of your posts advocate serious harm and trauma.
Please stop the harassment!

Debriefing?

And this:

Cygnus Lindsey: Amy you’re a nasty ass bitch. Like a damn dog salivating waiting for a crumb to drop. Fuck you old wench!

Where did I go wrong? How did they get the impression that I care about their opinions?

Be that as it may, I feel confident that they know what they did is wrong and now they are they engaging in a variety of cognitive distortions in an attempt to shed guilt, including:

It was unpreventable. In this case, they insist that if I knew the facts about what happened, I wouldn’t blame anyone. Yet no one seems to be able to come up with any facts that I got wrong.

Women have the right to do this. Yes, they have the legal right to risk their unborn children’s lives, but that doesn’t make it ethical or justifiable.

Unassisted birth is actually good for babies. Yes, this time the baby died, but had the baby lived an unassisted birth would have provided benefits for the baby.

The baby wanted it. No one invoked that here, but in previous cases mothers have claimed that the baby communicated to them where and how the he or she wished to be born.

The mother and her defenders did not pioneer these excuses. They’ve been used by child abusers since time immemorial.

Yes, I violently shook the baby for crying, but how was I supposed to know it would die?

It’s my right as a parent to beat my children bloody if I think it is for their own good.

Spare the rod, spoil the child.

If they didn’t want to be punished, they wouldn’t have misbehaved.

Those who harm children have a million excuses about why they aren’t responsible for the resulting injuries and deaths.

But the truth is that no one beats a child to death out of love; they do it to satisfy their own impulses and needs.

And the truth is that no one plans an unassisted pregnancy and birth out of love; they do it to satisfy their own impulses and needs.

The truth is that while parents have a right to discipline their children; they have responsibilities as well.

And the truth is that while mothers have a legal right to let their unborn babies die in service to their cognitive delusions, they have the ethical responsibility to provide appropriate medical care.

The truth is that children don’t benefit from being beaten; the parents benefit.

And the truth is that babies don’t benefit from unassisted pregnancy and birth; the mother benefits from bragging rights and the toxic “support” of other members of the Facebook group.

Unassisted pregnancy and birth are child abuse, albeit entirely legal. And if YOU support an abuser, YOU bear responsibility for tragedies like this one.

Homebirth, like most of alternative health, is about two things. Not mother and baby; don’t be silly! It’s about defiance and denial.

Homebirth especially is about defiance. Women routinely risk their baby’s lives — the greater the risk, the better — while flaunting their transgressiveness before their peers. That’s why there are so many Facebook groups built around the specific complication they are defying. Groups like Ten Month Mamas and its secret section.

Hi everyone! This group was recommended to me because I am currently 44+2. I’m excited to look through the posts and see if I can find some like minded support.

If she was looking for like minded, self-absorbed idiots, she came to the right place!

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The mother piled risk factor on risk factor until they eventually crushed the life out of her baby.[/pullquote]

The group is headlined with a typically moronic quote from killer pretend midwife Gloria Lemay, who has more deaths to her name than anyone even knows.

Attending births is like growing roses. You have to marvel at the ones that just open up and bloom at the first kiss of the sun but you wouldn’t dream of pulling open the petals of the tightly closed buds and forcing them to blossom to your time line.

Awesome advice for gardening. Idiotic for childbirth. That’s because for every week beyond 40 weeks that babies stay inside the womb, the risk of stillbirth rises … and rises … and rises. The risk of stillbirth doubles at 42 weeks, triples at 43 weeks, and continues to rise beyond.

If you wanted to use a gardening analogy, you might analogize to plants that get root-bound. Both the root-bound plant and the postdates baby grow beyond the size of their sustenance. It both cases they sicken and eventually die.

In the world of homebirth, more complications and greater idiocy are worth more atta-girls. One week after her initial post, Mom informs the group that in addition to extreme postdates, she’s added on prolonged rupture of membranes. Why not? She’s already had an unassisted pregnancy (no medical care by anyone) and plans an unassisted birth (no medical care by anyone). Mom gets her atta-girls.

But wait! There’s more. There is meconium in the fluid and Mom thinks the baby is transverse! More atta-girls.

Finally, three days later, the mother consents to induction!

But as she knew, the baby was already dead.

On July 28th [my partner] and I brought Earthside our sweet Angel baby. We discovered her heart had stopped beating before birthing. Unfortunately we had to say Goodbye in the same breath as Hello and were able to bring her home in our hearts, but not our arms…

Who could have seen that coming?

Anyone with a shred of common sense.

Unassisted pregnancy and birth have appalling rates of perinatal mortality. Postdates increases the risk of death, Prolonged rupture of membranes increases the risk of death. Meconium increases the risk of death. Transverse lie increases the risk of death. Put them all together and what do you get? A dead baby!

But as this mother piled risk factor on risk factor until they eventually crushed the life out of her baby, she was cheered on by women who are so privileged that they have forgetten that childbirth is dangerous and so immature that they think defiance marks them as authentic.

This baby did not have to die. She was killed by her mother’s choices and the group of like minded fools who supported her.

I’ve been writing about mothering issues for over a decade and that gives me an interesting perspective on lactivist marketing campaigns: they’re constantly changing because they never work to lactivists’ satisfaction.

The latest campaign has been trotted out for World Breastfeeding Week 2017: ending poverty, protecting the planet and ensuring prosperity. This campaign is going to fail for the obvious reason that breastfeeding is incapable of doing any of those things and anyone with a modicum of sense would know that.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breastfeeding as a way to end poverty, protect the planet and ensure prosperity? That’s bullshit.[/pullquote]

But lactivism isn’t about common sense and it isn’t even about babies. It’s about marketing the products and services of the breastfeeding industry while pretending that all women need these products and services and all babies benefit from these products and services. That’s why the moralization of breastfeeding has paralleled the monetization of breastfeeding.

The primary lactivist goal is unreasonable: to ensure nearly 100% exclusive, extended breastfeeding. It’s simply not biologically possible since the incidence of insufficient breastmilk supply is common, not rare (a lactivist lie). The goal is also anti-feminist. One of the cornerstones of feminism is the right of women to control their own bodies including their breasts. The lactivist goal is also absurd. For most of human existence there was nearly 100% exclusive, extended breastfeeding, and infant mortality rates were astronomical.

Before addressing why the World Breastfeeding Week 2017 campaign is the most ridiculous yet, it’s worth reviewing the previous campaigns.

The heart and soul of contemporary lactivism is lying about the benefits and risks. Breastmilk is literally presented as the “perfect food” for babies. But for a food to be perfect for babies, it needs to meet three criteria:

• It must be nutritionally complete.
• It must be available in the perfect amount.
• A baby must be able to access as much as he or she needs.

Breastmilk is not nutritionally complete; it lacks vitamin D. Many women don’t make enough breastmilk to fully nourish an infant. And many infants have impediments (low muscle tone, poor suck) that make it impossible for them to access as much milk from the breast as they need.

But claiming breastmilk as perfect for all babies is only the beginning of the lactivist lies. Lactivist organizations — and sadly the WHO and UNICEF under the relentless lobbying of lactivist organizations — has insisted that the scientific evidence shows that breastfeeding has a host of health benefits. Most of the scientific evidence about breastfeeding is weak, conflicting and riddled with confounders. Since breastfeeding in industrialized nations is associated with maternal socio-economic status, most of the benefits claimed for breastfeeding are actually benefits of being well off with easy access to healthcare. No matter, lactivism has positioned fear of depriving babies of benefits as critical to their efforts.

Even lying about breastfeeding hasn’t been able to achieve lactivist goals, so they’ve extended their campaign in a variety of ways.

For years, “normalizing” breastfeeding has been a centerpiece of lactivist efforts. Ignoring what women told them about why they stopped or didn’t start breastfeeding — it can be painful, frustrating, exhausting and inconvenient — lactivists insisted that breastfeeding rates are low because of social pressure to formula feed. They embarked upon a relentless, multimillion dollar campaign to normalize breastfeeding, in other words to apply social pressure to breastfeed. Although many more women leave the hospital claiming they will breastfeed, and many more women feel guilty about not breastfeeding, the lactivist goal of 100% breastfeeding is nowhere in sight.

Critics of lactivism pointed out that it takes a village to raise a child, not a breast and therefore pressuring individual women to breastfeed is a classic neoliberal response to a health issue: putting the blame on individuals and discounting the role of government. Lactivists have responded with a new iteration in which government is condemned for not supporting breastfeeding enough — although it is supporting breastfeeding with more money and greater effort than any time in the past.

Moreover, it has become obvious that breastfeeding has risks as well as benefits. Critics have drawn attention to serious complications and deaths from insufficient breastmilk. The Fed Is Best Foundation has led the way in this area and its spectacular success in changing the dialogue is testament to the widespread nature of breastfeeding problems. How have lactivists responded? They’ve responded with unadulterated chutzpah. After literally decades of promoting breastfeeding by making women fear formula as substandard and a sign of personal weakness, lactivists have had the unmitigated gall to decry the fear generated by informing women about the fact that insufficient breastmilk is common, not rare.

World Breastfeeding Week 2017 represents a new acme in lies about breastfeeding: it’s not just a feeding method; it’s a way to end poverty, protect the planet and ensure prosperity. That’s bullshit.

According to WBW2017:

Breastfeeding is a vital part of sustainable development and a non-negotiable component of global action to end malnutrition…

Really? For most of human existence, when all babies were breastfed, there was never any hunger or malnutrition? Actually, as everyone knows, hunger and malnutrition were ubiquitous. Breastfeeding never prevented hunger and malnutrition in the past and it isn’t about to start now. Breastmilk does not come from thin air; it is produced from food eaten by mothers. No food for mothers = no breastmilk for babies. Unless and until breastmilk causes food to grow, it will never prevent hunger and malnutrition.

The health of our planet is affected by the way babies are fed. Breastmilk is a natural, renewable food that is produced and delivered without pollution, packaging or waste. The breastmilk substitute industry, on the other hand, carries a negative environmental impact that is not commonly recognised…

That’s hilarious! How green is the extra food (including meat from cows) needed to create breastmilk? Is there any evidence that the production of breastmilk takes less farming, fertilizers and transportation of food than the production of cow’s milk? How green is the plastic used in breast pumps? How green is the electricity used to run the pump and store the refrigerated or frozen breastmilk? How green are breast pads, nursing bras and lactation consultants (fuel needed to get to and from patients)? Oops! Maybe breastfeeding isn’t that green after all!

How about the claim that breastfeeding increases prosperity? The folks at WBW2017 don’t even bother to provide evidence of that, presumably because there is no such evidence.

The truth — an inconvenient truth that lactivists refuse to acknowledge — is that breastmilk is just milk, not magic. It doesn’t have magical health benefits. It doesn’t magically make women better mothers than those who formula feed. It doesn’t magically prevent hunger and malnutrition. It isn’t particularly environmentally friendly compared to formula feeding and it has no impact whatsoever on prosperity.

Therefore this campaign, like all the lactivist campaigns before it, is doomed to failure.

Lactivists are bemoaning the latest breastfeeding report from the World Health Organization.

As USA Today reports:

No country in the world supports breastfeeding moms like they should, according to a new report released Tuesday by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF)…

By comparing breastfeeding rates around the world, the groups found rates nowhere near 100% in its Global Breastfeeding Scorecard, released at the start of World Breastfeeding Week.

So what?

No matter how long and hard professional lactivists bleat about the purported life saving benefits of breastfeeding, very few parents actually believe them, nor should they. The truth, which lactation professionals refuse to acknowledge, is that breastfeeding rates have virtually nothing to do with infant health.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There is literally zero real world evidence that promoting breastfeeding improves infant health.[/perfectpullquote]

Don’t believe me? Consider which countries did best and worst on the WHO breastfeeding report card.

Only 23 countries report exclusive breastfeeding rates at 6-months above 60%: Bolivia, Burundi, Cabo Verde, Cambodia, Democratic People’s Republic of Korea, Eritrea, Kenya, Kiribati, Lesotho, Malawi, Micronesia, Federated States of Nauru, Nepal, Peru, Rwanda, São Tome and Principe, Solomon Islands, Sri Lanka, Swaziland, Timor-Leste, Uganda, Vanuatu and Zambia.

By and large, these countries have terrible rates of infant mortality (expressed per 1000 live births):

Bolivia 31
Burundi 54
Cabo Verde 21
Cambodia 25
Democratic People’s Republic of Korea 20
Eritrea 34
Kenya 36
Kiribati 44
Lesotho 69
Malawi 43
Micronesia 29
Federated States of Nauru 29
Nepal 29
Peru 13
Rwanda 31
São Tome and Principe 35
Solomon Islands 24
Sri Lanka 8
Swaziland 45
Timor-Leste 45
Uganda 38
Vanuatu 23
Zambia 43

In contrast:

Laurence Grummer-Strawn, technical officer with the World Health Organization, said the U.S. received “several red lights” or “failing grades” in the report. Rates in the United States were considerably lower than the average. Fewer than 25% of American moms report exclusively breastfeeding for the first six months. The United States has no paid maternity leave, and data showed only 18% of hospitals support recommended breastfeeding practices. Grummer-Strawn also pointed out there’s no regulation on how baby formula is advertised in the U.S., a reason moms could think formula is a substitute for breastmilk.

But the infant mortality rate in the US is 6/1000, a fraction of the rate in any of the countries given the best grades by the WHO.

The United Kingdom, by all accounts, does even worse with a breastfeeding rate at 12 months of 0.5%, reportedly the lowest in the world … and yet the infant mortality rate in the UK is even lower than the US, 4/1000, one of the best rates in the world!

These figures make is nearly impossible to take UNICEF and the World Health Organization seriously when it asks for ever more money to promote breastfeeding:

The groups are asking for lower and middle-income countries to invest $4.70 per newborn ($5.7 billion) in initiatives, such as access to breastfeeding counseling and improving breastfeeding practices in hospitals, to increase the global rate of 6-month exclusive breastfeeding to 50% by 2025. The Global Breastfeeding Collective suggests such an investment could save the lives more than 520,000 children under age five who die of preventable illnesses, annually, and could generate up to $300 billion in economic gains.

All the existing real world evidence suggest that that can’t possibly be true and isn’t even close to reality. So where do such claims come from? They come from mathematical models that assume that when breastfeeding rates are correlated with low infant mortality, they cause low infant mortality. But as anyone with even a passing acquaintance with statistics can tell you, correlation does not equal causation. The figures quoted above demonstrate that definitively.

Nonetheless, the UNICEF and WHO claims, which have no basis in fact, have been widely disseminated and accepted as conventional wisdom.

A piece published yesterday on the Fast Company website is typical:

We really need to act now to fully realize the benefits of breast feeding,” says France Begin, a senior advisor with UNICEF’s infant and young child nutrition division. “Prioritizing breast feeding will save lives, save money, and will lead to better health and economic outcomes for generations to come.

Yet there is literally ZERO real world evidence that prioritizing breastfeeding will do any of those things. In the real world, there is NO correlation between breastfeeding rates and infant mortality rates. Countries with the highest breastfeeding rates have HIGH infant mortality and countries with the lowest breastfeeding rates have LOW infant mortality.

There is NO real world, population based data to indicate increasing breastfeeding promotion or improving breastfeeding rates would have ANY impact on any infant health of term babies.

Indeed, I posted a challenge on Facebook and Twitter yesterday:

Take the Dr. Amy World Breastfeeding Week Challenge: Please find any example of industrialized countries where promoting breastfeeding reduced infant mortality.

Thousands of people have viewed the challenge but not a single person has offered a single example. That’s not surprising. There are no examples.

Not a single country in the world meets WHO standards for breastfeeding? So what?

It’s an amazing fluid with amazing properties. It is critical to health and well being. It is adaptive: it’s amount and constituents can change as circumstances change. Human beings could never have survived and thrived to this point without it.

No, it’s not breastmilk. It’s sweat … and it’s arguably just as important to human survival as breastmilk.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Why is there World Breastfeeding Week and no World Sweating Week?[/pullquote]

So why is there a World Breastfeeding Week and no World Sweating Week?

Because there are special interest breastfeeding groups that have lobbied government to support them in promoting their product. World Breastfeeding Week is ostensibly about promoting infant health, saving money and increasing sustainability, but the truth is that the benefits of breastfeeding have been grossly exaggerated, the “dangers” of formula feeding mostly fabricated, and the risks of exlusive breastfeeding hidden or denied. Indeed, at this point, the harms of breastfeeding promotion — infants injured, infant deaths, maternal mental health compromised — arguably outweigh the benefits.

It’s time to stop the madness!

Let’s start with a fundamental premise:

Promoting process over outcome is wrong.

We’ve all heard the expression, “The operation was a success, but the patient died.” It’s an aphorism that memorably expresses the folly of valuing process over outcome.

Breastfeeding is a process. Infant health is the outcome and it is infant health that should matter, not breastfeeding rates. Lactivists have managed to elide this critical issue by starting with the dubious conclusion — that breastfeeding must be healthier because it is natural — and promoting scientific data that is weak, conflicting and riddled with confounders to support it.

The scientific literature on breastfeeding affirms over and over again that breastfeeding is theoretically healthier for babies. But we don’t have to resort to theory when we have reams of actual data. Over the past 100 years we performed a major “experiment” in industrialized countries. Breastfeeding rates, which in the US were in the range of 90%, dropped precipitously to 24% by 1973 and have since rebounded to initiation rates of nearly 80%. What impact have actual breastfeeding rates had on real life populations in industrialized countries? They’ve had no discernible impact at all. The infant mortality rate dropped steadily regardless of whether breastfeeding rates were rising or falling.

But what about middle and lower income countries where access to clean water to prepare infant formula is uncertain? Surely breastfeeding rates must have a significant impact on infant mortality rates.

Here’s a scatter chart of breastfeeding rates vs. infant mortality created from data on 121 low and moderate income countries.

As you can see, as the breastfeeding rate rises, the infant mortality rate not only doesn’t fall, it actually rises, too. In other words, there is no correlation between breastfeeding rates and infant mortality rates. But, as demonstrated below, there is a strong correlation between economic activity and infant mortality.

There’s no evidence here that increasing breastfeeding rates improved infant health.

But breastfeeding is natural!

So is sweat. Indeed breastmilk is actually modified sweat and the breast glands are modified sweat glands.

Sweat is critical to human survival because it is a primary method of thermoregulation, regulation of the body’s internal temperature. People who cannot sweat face the very real threat of death from drastically elevated body temperature. Given the lifesaving nature of sweating, you might think it would be accorded the same treatment as breastfeeding, but you would be wrong.

Consider:

It is widely recognized that temperature outstripping the ability to sweat is common. That’s why we recommend additional cooling methods like cold drinks and immersion in cool water. In contrast, lactivists refuse to accept that a mother’s ability to produce breastmilk can be outstripped by a baby’s needs for nourishment. Both are natural but only one is presumed to be nearly perfect.

It is widely accepted that using technology for cooling, like fans and air conditioning, is often superior to sweating. In contrast, lactivists insist that using technology, in this case infant formula, can’t possibly be as good as breastfeeding.

No one thinks that people who use technology to cool themselves are lazy or selfish, yet lactivists often assert that women who refuse to breastfeed are lazy and selfish. Many mothers are left with shame and guilt when they cannot meet the arbitrary lactivist imperative to breastfeed.

Cooling technology saves lives and improves quality of life. Sure, sweating is great and quite effective, but fans and air conditioners are far more pleasant and allow people to be productive in hot climates or during heat waves. In truth, infant formula also saves lives and improves quality of life for both mothers and babies, but lactivists vehemently deny what it right in front of their eyes and what mothers tell them.

Hence we have World Breastfeeding Week, when activists insist that babies’ health is threated by low breastfeeding rates, though there is no evidence of this; that infant health will be improved if more women breastfeed exclusively, though there is no evidence of this; that women stop breastfeeding because of lack of support, though women report that they stop because of low supply, pain and inconvenience; and that society doesn’t promote breastfeeding, even though tens of millions of dollars are spent each year doing just that.

It’s time to stop the madness!

Yes, breastfeeding is a good thing, but it produces milk, not magic, no matter how much lactivists pretend otherwise. And like any bodily process (think fertility or pregnancy), it has a significant failure rate, not a low rate. The decision to breastfeed instead of use formula is like the decision to sweat instead of using air conditioning. It doesn’t make people superior; those who choose not to do it aren’t lazy or selfish; and, most importantly, it’s a personal choice, not the appropriate purview of activists or governments.

Many women proudly identify themselves as “crunchy” mothers. It is meant to invoke granola — natural and healthy. But there’s no evidence that crunchy mothering is more natural or healthier, just like there’s no evidence that granola existed in nature.

Yet the appellation is more accurate than crunchy mothers realize. Granola is hard, unyielding, but it is easily smashed and becomes soggy and falls apart with the application of milk. And though crunchy mothers like to pretend that they are child centered and self-sacrificing, the truth is that crunchy mothering is rigid and performance obsessed, the audience being other mothers.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Supple mothering — adaptable, resilient, respectful of children’s differences and kind to mothers.[/pullquote]

Good mothering has nothing to do with being crunchy and everything to do with being both supple and resilient, qualities that can’t be found granola. What do I mean?

Supple mothering is adaptable; crunchy mothering is not.

The greatest defect of crunchy mothering is that it rests on the belief that one size fits all. Unmedicated vaginal birth is supposedly right for every baby and every mother; breastfeeding is supposedly best for every child and every mother; baby wearing is supposedly comfortable for every child and every mother; the family bed supposedly meets the needs of all.

If I’ve learned anything at all from mothering four children, it is that one size NEVER fits all. Every child is a unique person with individual needs that can differ subtly or dramatically from other children. Supple mothering means being able to conform to the individual child’s needs and desires whether that child needs a C-section in order to survive, formula feeding in order to thrive, or anything else that may not be part of a mother’s image of how she planned to mother or what she imagined her child might become.

Supple mothering is resilient; crunchy mothering is not.

Mothering is an extremely stressful and demanding job. My children are grown and though the physical work has receded into the past, the emotional imperatives have not. They know that I still worry about them (and are probably annoyed about it); they are sure that I will glory with them in their successes, and they can be confident that I will take their disappointments as hard or even harder than they do. I am always in their corner and have been since the day each was born.

In order to be there for them, I have had to be resilient and part of resilience is being realistic in my expectations of them and of myself. Supple mothering allows for that. It predicts that mothering will not be easy; it anticipates that children will not always adhere to the goals you have in mind for them or for yourself and it counsels adaptation not rigid adherence to a pre-existing plan.

Supple mothering also teaches women to be good to themselves. A woman who chooses an epidural in labor is not “giving in”; she is meeting her own need for pain relief. A mother who chooses not to breastfeed (even when she could have done so) is not selfish; she’s appropriately caring for herself. A mother who needs to sleep without a baby her in her bed is not depriving her child; she is shoring up her own reserves to improve her ability to parent that child.

Moreover, supple mothering allows women to adapt to their children. I have a friend who insisted that she would never let any daughter of hers play with Barbie dolls. Then she had a daughter who loved Barbies. Despite the fact my friend abhorred Barbie, she ultimately gave in to her daughter’s entreaties and bought her several. That took guts and humility, recognizing that perhaps she did not necessarily know what was best for this particular girl. Barbie turned out to be a passing fancy and her daughter never fell prey to the belief that she was expected to look like Barbie or behave in docile way. Supple mothering views adaptation as a strength, not a weakness.

Supple mothering supports; crunchy mothering blames.

One of the best books about parenting I ever read is Far From The Tree by psychiatrist Andrew Solomon. It’s about one of the most challenging aspects of parenting, recognizing that your child is not you and that’s okay. The task is made far more difficult when the child differs from you in major ways: children who are deaf, autistic, transgender, etc.

Solomon notes:

… The attribution of responsibility to parents is often a function of ignorance, but it also reflects our anxious belief that we control our own destinies. Unfortunately, it does not save anyone’s children; it only destroys some people’s parents, who either crumble under the strain of undue censure or rush to blame themselves before anyone else has time to accuse them …

Though Solomon writes of extreme parenting challenges, the urge to blame is  integral to crunchy mothering. That’s why crunchy mothering groups are filled with women who deride other mothers who had epidurals or C-sections, and who feel entirely comfortable insisting that women who don’t breastfeed are lazy. It’s both a function of ignorance about childbirth and breastfeeding, as well as the desperate belief that mothering is a matter of imposing your will. In fact the crunchy mothering ethos has become so ingrained in middle class white women that they don’t wait for others to blame them; they blame themselves and feel guilty about epidurals, C-sections, formula feeding, or something as basic and banal as needing sleep in order to function.

That’s why lactivist groups are hell bent on attacking The Fed Is Best Foundation for supporting ALL women REGARDLESS of the ways they feed their babies. Crunchy mothering is incapable of supporting women who make different choices; it can only blame. Lactivists think the ability of Fed Is Best to offer support regardless of circumstances is a weakness and betrayal of breastfeeding when, in truth, it is an evocation of supple mothering. It counsels women to be adapatable when it comes to infant feeding and to reject guilt for refusing to adhere to rigid rules about breastfeeding. And it saves lives, too. Crunchy mothering is so rigid and demanding that letting babies die from hypernatremic dehydration is waved off as “rare” when the reality is that it is common.

Supple parenting lets mothers save their strength for real parenting challenges; crunchy mothering pretends that trivial decisions are parenting challenges.

Childbirth, infant feeding, and issues like the family bed AREN’T the hard parts of parenting and they aren’t the important parts, either. They pale into insignificance behind the real challenges of parenting: dealing with differences, disabilities, bullying, poor school performance, lack of friends, major disappointments, risky behavior, drug use, depression and drunk driving. And that’s hardly an exhaustive list.

It takes strength to deal with these challenges, strength that should be husbanded, not wasted on meaningless issues like childbirth and infant feeding. There’s absolutely no need to feel guilty about safe mothering choices like C-sections and formula feeding. What should you feel guilty about? I guarantee that once they are old enough to talk your children will tell you … and tell you … and tell you.

The bottom line is that crunchy mothering isn’t good for children and it isn’t good for mothers. We should reject it. Our goal should be supple mothering — adaptable, resilient, respectful of children’s differences and kind to mothers.

It’s hard to believe that a three word phrase could provoke such angst, but that’s what has happened with Fed Is Best.

Milky Mommas is the latest organization to spill ink and anger over Fed Is Best:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Fully fed with formula is just fine.[/pullquote]

It’s because saying “fed is best” is saying that all options are equal, that infant feeding methods don’t matter. That no matter what you choose, it’s all the same, it’s all “best” for baby. And that is scientifically inaccurate.

I’ve got some bad news for the folks at Milky Mommas:

The choice between breastfeeding and formula feeding DOESN’T matter. No matter which you choose, it IS all the same; in industrialized countries formula is as good if not better than breastfeeding.

I’m sorry that this is hurtful for those who have wrapped their self-esteem around the function of their breasts, but frankly, it is no different — and no less inappropriate — to derive self esteem from lactating breasts than from large breasts. Women should not be judging themselves and each other by body parts. That’s the kind of objectification that harms all women.

The beauty of the phrase Fed Is Best, coined by Christie del Castillo-Hegyi, MD and lactation consultant Jody Seagrave-Daly, RN, is that it punches through all the rhetoric to get to the heart of the matter:

Fully fed with formula beats underfed with breastmilk every time.

Like the most successful mantras, Fed Is Best truly resonates. The first time most people hear it, the response is “Of course! I should have realized that.”

Fed Is Best has the ultimate advantage: it’s actually true. That’s what makes it so dangerous for lactivists. Insisting that “breast is best” for all babies, for all mothers, at all times — the hardest of hard lines — throws the fundamental error of lactivism into sharp relief: a process can NEVER be more important than a healthy outcome.

Diane Weissinger, one of the architects of contemporary lactivism realized that:

When we … say that breastfeeding is the best possible way to feed babies because it provides their ideal food, perfectly balanced for optimal infant nutrition, the logical response is, “So what?” Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy and thus safety and adequacy-of artificial feeding …

Weissinger understood that when you tell women the truth about formula feeding — that it is safe, adequate and normal — they won’t feel compelled to breastfeed. Therefore, breastfeeding must be reframed with lies.

The mother having difficulty with breastfeeding may not seek help just to achieve a “special bonus”; but she may clamor for help if she knows how much she and her baby stand to lose. She is less likely to use artificial baby milk just “to get him used to a bottle” if she knows that the contents of that bottle cause harm.

In other words, contemporary lactivism rests on a deliberate lie; there is no evidence, and there has never been any evidence, that formula is harmful. Yet Milky Mommas blithely repeats the lie without having any idea of its origin:

What we are saying is that there are certain risks associated with formula (well documented in many, many studies) and that it is not a NUTRITIONALLY equal choice to breastfeeding.

There are no risks associated with formula and there never were. Claiming that formula feeding has risks is and has always been nothing more than a marketing tactic designed to promote the employment prospects of lactation consultants. Now Milky Mommas is concerned about the blow to their self-esteem that would come from acknowledging that “breast is best” was never anything more marketing bombast.

What we are saying, is that while we support our members who must use formula, pretending that what our babies are fed doesn’t matter contradicts everything we stand for.

I am sorry — and truth be told, a bit sickened — that organizations like Milky Mommas stand for the proposition that breastfeeding makes them better mothers and women. But the fact that they have chosen to stake their self-esteem on lactating doesn’t strengthen their case; it weakens it.

It’s no different than creationists who feel that evolution contradicts everything they stand for. They reject evolution because it calls their beliefs about themselves and the world into question, but that doesn’t change the fact that evolution is the only scientifically coherent explanation for the world as it exists. Milk Mommas reject the incontrovertible claim that fully fed with formula beats underfed with breastmilk every time because it calls their beliefs about themselves and the purported importance of breastfeeding into question. But that doesn’t change the fact there is simply no population based data that shows that breastfeeding rates have anything to do with infant mortality rates for term babies.

Lactivists constantly invoke mathematical models based on extrapolation from small studies in order to insist that breast is best, but there’s no need to create mathematical models when we have real world data. During the past century, breastfeeding rates have fluctuated dramatically from nearly 90% down to 24% and back up to about 76%. During that entire time, and involving literally tens of millions of babies, there has never been any evidence that breastfeeding rates impact major health indices for infant and children in any way.

Therefore, Milk Mommas is fundamentally wrong in their view of the science and themselves. They claim:

We are here to educate and advocate for the use of human breast milk. We understand the value and importance of human breast milk. That’s the science of health, not a judgement on mothers.

I’ve challenged a wide variety of lactation professionals to provide real world, population based evidence that breastfeeding makes a difference to infant health and they can’t because such evidence does not exist.

So what are Milky Mommas advocating for if there’s no evidence that breastfeeding has a meaningful impact on infant health? They’re advocating for themselves and their desperate desire to believe that they are better than mothers who make different choices.

That’s not science, just an unattractive facet of human nature.