I’m sure you will be shocked, shocked to learn that The Alpha Parent has been caught lying.

Who would have thought that Allison Dixley, Kommandant of the Breastapo, would lie outright in her efforts to promote her personal brand of parenting? Sure she habitually spews mistruths, half truths and lies about breastfeeding. I guess she’s been getting away with it for so long that she figured she could extend the lying to C-sections.

What did she do? She posted this:

Given the wording, you might have thought that the ugly scar depicted in the image is a C-section scar. You would be wrong. It’s an abdominoplasty (tummy tuck) scar. How do I know? Aside from the fact that the original image described it as an abdominoplasty, you can tell because it is approximately 3X longer, extending from hip bone to hip bone, it involves tremendous bruising, and it is clearly not the fresh incision of a recently pregnant woman since her abdomen is flat.

Allison was caught out by her followers and everyone else. It was the perfect visual representation of the fundamental dishonesty of the typical crap that she spews about breastfeeding and formula feeding.

Allison doesn’t deny that she illustrated her message about C-sections with a picture of an entirely different, far more extensive surgery. How does she she justify the deception? It’s dramatic license! Excuse me while I pick myself up off the floor where I fell when laughing uncontrollably.

For those getting their thong trapped, remember this cosleeping ad? It wasn’t suggesting that babies actually sleep with knives. It’s called dramatic licence. Move on.

Good to know, Allison. So that means that the image heading this post where I slap the label “LIAR!” on your logo is just dramatic license, too.

Bad news, Allison, your image does not represent dramatic license. It represents lying with images. As you so accurately point out, no one would look at the co-sleeping ad and imagine that it represents reality. It is a graphical analogy. You weren’t making an analogy with your image; you were simply telling a lie, trying to pass off an abdominoplasty incision AS a C-section incision.

No matter. What I love about people like Allison is that they make my job so much easier. I could tell you that Allison lies when it suits her purposes, but it’s far more powerful when she demonstrates her utter disregard for the truth. You can’t believe a word that woman says about breastfeeding, about C-sections or about anything else. She lies, and she thinks it’s okay to lie. You’d be a fool to take anything she writes seriously.

Talk about making lemonade out of lemons! Only a Dutch midwife could take the fact that the Netherlands has one of the highest perinatal mortality rates in Western Europe and the fact Dutch midwives caring for low risk women (home or hospital) have a higher perinatal death rate than Dutch obstetricians caring for HIGH risk women and turn it into a defense of homebirth.

But those facts are not a defense of homebirth; they are a scathing indictment of Dutch midwifery. Ank de Jonge’s new paper in BJOG tells us the same thing most of her old papers tell us: Dutch midwives provide substandard care.

This is the fourth paper that I know of where de Jonge presents misleading information in an effort to promote homebirth. I could almost feel sorry for her since her efforts serve only to highlight the deficiencies of Dutch midwives.

de Jonge thought that she had succeeded in showing that homebirth in the Netherlands is safe. She was the lead author on the paper Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births back in 2009. The study showed that homebirth with a midwife in the Netherlands is as safe as hospital birth with a midwife. That triumph was very short lived.

A subsequent study, Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study, was a stunning indictment of Dutch midwives. The study was undertaken to determine why the Netherlands has one of the worst perinatal mortality rates in Western Europe and the results were unexpected, to say the least.

We found that delivery related perinatal death was significantly higher among low risk pregnancies in midwife supervised primary care than among high risk pregnancies in obstetrician supervised secondary care.

In 2013 de Jonge in a paper in the journal Midwifery Perinatal mortality rate in the Netherlands compared to other European countries: A secondary analysis of Euro-PERISTAT data that attempted to absolve Dutch midwives, but actually CONFIRMED their poor mortality statistics

Later in 2013 de Jonge published Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study. de Jonge found that there were fewer serious maternal complications at homebirth than hospital birth. There was just one teensy, weensy problem. de Jonge left out the mortality rates. Severe maternal morbidity is an appropriate measure of safely ONLY when death rate is zero or nearly zero. If the death rate is not zero, that MUST be taken into account in assessing safety. It was subsequently revealed that the homebirth group had a potentially preventable maternal death while the hospital group had none.

de Jonge’s latest paper is Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases,  She found:

Of the total of 814 979 women, 466 112 had a planned home birth and 276 958 had a planned hospital birth. For 71 909 women, their planned place of birth was unknown. The combined intrapartum and neonatal death rates up to 28 days after birth, including cases with discrepancies in the registration of the moment of death, were: for nulliparous women, 1.02‰ for planned home births versus 1.09‰ for planned hospital births, adjusted odds ratio (aOR) 0.99, 95% confidence interval (95% CI) 0.79–1.24; and for parous women, 0.59‰ versus 0.58‰, aOR 1.16, 95% CI 0.87–1.55.

And concluded:

We found no increased risk of adverse perinatal outcomes for planned home births among low-risk women. Our results may only apply to regions where home births are well integrated into the maternity care system.

But the combined intrapartum/neonatal death rates for both groups was higher than would be expected for a group of low risk women in midwifery care. Indeed, it is higher than the intpartum/neonatal death rate of 0.74/1000 (nullips) and 0.46 (multips) previously reported for HIGH risk patients under the care of Dutch obstetricians.

de Jonge, of course, was careful to leave out the death rates of Dutch obstetricians, though she does acknowledge that previous studies have shown midwifery mortality rates for babies of low risk women to be higher than those of obstetricians caring for high risk women.

de Jonge concludes:

This study did not show increased risks of intrapartum and neonatal mortality, among low-risk women planning a home birth.

That’s true as far as it goes but a more accurate conclusion would be:

This study did not show increased risks of intrapartum and neonatal mortality among low-risk women planning a home birth with a midwife compared compared to low-risk women planning a hospital birth with a midwife. It does, however show an increased risk of intrapartum and neonatal mortality among low risk women in midwifery care compared to HIGH risk women in obstetrical care.

de Jonge didn’t show that homebirth is safe. She showed that Dutch midwives are dangerous.

I could almost feel sorry for homebirth advocates. Their need for validation is so desperate, so pathetic, that they view other women’s birth choices through the prism of their own need.

Blogger Milli Hill is a perfect example. You may remember Hill as the fool who made this ridiculous statement:

If you believe everything you read, then you probably think that childbirth is one of the riskiest activities any human can undertake.

Actually, it isn’t, and statistically you’re massively more likely to meet your maker behind the wheel of your motor.

When it was demonstrated to Hill that she has no idea what she is talking about, that childbirth is far more dangerous that getting in a car, and is a leading cause of death of young women and the single most dangerous day of the entire 18 years of childhood, she petulantly responded with this gem:

I don’t say birth is not risky. Life is risky. Picking your nose is risky…

Hill’s ignorance is exceeded only by her desperation. Homebirth advocates like to claim that they are “empowered” by homebirth, but how empowered can you be if you are constantly seeking validation by having others mirror your choices back to you. In her latest piece “Dear Kate, please have a home birth this time!” Hill explains her need:

“Everybody has to make their own choices”, you find yourself saying, but the problem is, if you’ve had a baby out of hospital yourself, you’ve got this secret slightly unhinged alter ego hopping around in your head singing, “Have a home birth! Have a home birth!”. You know it’s best not say this out loud, but the problem is, home birth is so wonderful it’s almost impossible not to be evangelical about it.

Here, Milli, let me help you with that:

“Everybody has to make their own choices”, you find yourself saying, but the problem is, if you’ve had a baby out of hospital yourself, you’ve got this secret slightly unhinged alter ego hopping around in your head desperate to have your own choices mirrored back to you, “Have a home birth! Have a home birth!”. You know it’s best not say this out loud, but the problem is, you are so obsessed with your pathetic need for validation and your own lack of confidence that you desperately need to be evangelical about it.

Like most homebirth advocates, Hill isn’t merely aggressively ignorant about childbirth, she’s evidence resistant. She now knows and has admitted that childbirth is far more dangerous that she ever understood. No matter, she simply ignores the new facts that she has learned because she prefers fantasy to reality:

As a culture we’re completely terrified of birth, mostly as a result of TV documentaries and soaps that portray having a baby as an agonising emergency bloodbath that happens so quick you don’t even have time to remove your tights…

As things stand at the moment, we’re pretty convinced that birth is dangerous, and that most women can’t do it without a spinal block and a team of medics. Home birth is therefore, “brave”.

No, Milli, no one thinks you are brave; they think you are stupid and self-absorbed, but are just too polite to say so.

There’s nothing brave about risking your child’s life for your birth “experience.” There’s nothing brave about pretending that you are educated when you are actually profoundly ignorant, lacking the most basic knowledge about science and statistics. And there’s certainly nothing brave about begging other women to copy you so you can feel better about yourself.

Is the Duchess of Cambridge a good candidate for homebirth? Does he Duchess of Cambridge have any interest in homebirth? Who cares? This isn’t about Kate and what is safe; this is about Milli and what she needs.

And this is where Kate comes in. For a sea change in attitudes, home birth needs an ambassador, and who better than a style icon adored by the world’s press?

I don’t know about Milli, but women who are really empowered don’t need ANYONE to validate the choices that are best for them and their families. They have enough confidence in themselves that don’t need style icons to mirror their choices back to them. There’s a word for that attitude; it’s called “maturity.”

Grow up Milli Hill, and stop looking to other women to make you feel good about yourself.

Hi, folks, Ima Frawde, CHC (certified home cardiologist) here to explain how to care for your heart at home.

It’s time for people to take back the care of their hearts from the cardiology industry and treat hearts as the natural organs that they are. Consider:

Animals don’t use cardiologists. Animals have existed for tens of millions of years despite the fact that animals in nature never use cardiologists. People are animals, too, so obviously we don’t need cardiologists, either.

If heart disease were really as big a problem as cardiologists claim, we wouldn’t be here. Cardiologists like to claim that literally hundreds of thousands of people each year require cardiac interventions. Really? Our ancestors didn’t have cardiologists and we’re still here.

All we need to do is eat and exercise like our paleolithic ancestors and care for our hearts with certified home cardiologists and everyone will be just fine.

What’s the difference between a CHC and an MD cardiologist? There are many, many important differences including:

Certified home cardiologists trust hearts. MD cardiologists act like people anybody could have a heart attack at any moment and that we must be prepared. Home cardiologists know that heart attacks are rare and that most of the time hearts work just fine.

Home cardiologists don’t do screening tests. Do you know that most people screened with tests like cholesterol levels and EKG’s DON’T actually have heart problems. It’s true; therefore you should reject any testing that might show you are at increased risk for heart problems.

Home cardiologists don’t pay any attention to risk factors. High cholesterol, abnormal EKG’s, obesity and smoking don’t make a patient high risk because they are just variations of normal.

Home cardiologists don’t play the “dead person card.” Instead of trying to scare you by claiming that heart attacks increase the risk of death, home cardiologists soothe their patients by insisting that there is no increased risk.

MD cardiologists do too many angioplasties and cardiac surgeries; home cardiologists do none. It is a well known fact that people who leave their heart care to home cardiologists have a much lower angioplasty rate and a much lower cardiac surgery rate. This dramatically reduces medical costs.

MD cardiologists do angioplasties and surgeries because they are rushing off to their golf games. Home cardiologists, on the other hand, take the time to watch your heart attack evolve.

Home cardiologists know that attitude is critically important. As our homebirth midwives sisters have taught us, merely mentioning complications causes them. That’s why we never ask our patients if they are having chest pain.

Chest pain is good pain. The heart is a muscle and like any muscle it may have pain when you exercise. Crushing chest pain is just a variation of normal. Plus, you know what they say: no pain, no gain.

Home cardiologists carry the same equipment as MD cardiologists. We carry drugs and oxygen, too, so what’s the difference?

The hospital is only 10 minutes away. MD cardiologists insist that if you are having crushing chest pain you should take a baby aspirin and call an ambulance. Why? You only need to go to the hospital if you are risk of dying of the heart attack, so there’s no reason to go to the hospital unless you your EKG flat-lines. Most of the time you don’t even need to take an ambulance. Your home cardiologist will just drop your unconscious body at the local emergency room.

And, the clincher:

People who have heart attacks die in the hospital, too. In fact MORE people die of heart attacks in a hospital cardiac care unit than at home.

If you can trust your baby’s life to a homebirth midwife, surely you can trust your own life to a home cardiologist. The reasoning is exactly the same.

There’s a paradox at the heart of homebirth advocacy. It depends entirely on the deeply held belief that no matter how poor the prenatal care, how stupid and incompetent the midwife, and how dangerous the unanticipated complication, the obstetricians at the local hospital will be able to save the baby’s life and the mother’s life.

There is probably no group of individuals in the world who has greater faith in obstetricians than homebirth advocates.

How do I know that? I learned long ago that watching what people do is far more revealing than listening to what they say. Sure homebirth advocates have lots of nasty things to say about obstetricians — they don’t follow scientific evidence, they just want to cut you, and horror of horrors, they think your baby’s life is more important than your birth plan — but in the end, what they do indicates that like they believe obstetricians have far more knowledge, skill and powers than even we think we have.

Every homebirth advocate and every homebirth midwife implicitly and explicitly assumes that in the event of disaster, they will simply transfer to the hospital (“It’s only 10 minutes away!”), where the obstetricians will do whatever it is they do to save the baby’s brain function and life.

But unlike the 99% of women bright enough to realize that obstetricians have the best chance to prevent injury, preserve brain function, and save lives of both mother and baby when you come to them BEFORE a disaster happens, homebirth advocates and homebirth midwives think so highly of obstetricians that they trust them to prevent injury, preserve brain function, and save lives of both mother and baby them AFTER the disaster has occurred at home.

Most people recognize the value of preventive medicine. It is much easier to prevent medical complications than to treat them. Obstetrics is preventive medicine writ large. Nearly every test and procedure in obstetrics is designed to predict complications by recognizing risk factors and by monitoring so that the complications can be detected in their earliest stages when they are easiest to treat.

But homebirth advocates and homebirth midwives often reject preventive medicine. They often refuse the routine tests of obstetrics designed to identify risk factors because they don’t want to know about the actual risks an individual patient faces. They often refuse the routine preventive care measures like antibiotics to prevent group B strep infection and vitamin K to prevent hemorrhagic disease of the newborn. It apparently makes perfect sense to them to wait until the disaster occurs before they seek treatment.

The types of complications most likely to prove deadly to babies share common characteristics. They typically result in oxygen deprivation to a baby and require either an emergency C-section or an expert neonatal resuscitation with intubation. They are situations which require operating rooms, anesthesiologists, neonatalogists and specialized equipment, none of which can be found at home or carried by a homebirth midwife. They are situations in which literally seconds matter, yet homebirth advocates are typically 30-45 minutes away from help of any kind. Despite all that homebirth advocates and homebirth midwives believe that obstetricians can save the day.

Simply put, homebirth advocates can promote the absolute nonsense that they so adore ONLY because they expect obstetricians to rescue them from their own folly. The dirty little secret of homebirth is that advocates and midwives don’t trust birth, they trust obstetricians.

It’s the biggest oxymoron in contemporary patient care. And now comes word that it may actually be killing babies. What is it? It’s the Baby Friendly Hospital Initiative (BFHI).

I’ve written about it before. There is nothing baby friendly about efforts to promote breastfeeding to the exclusion of a mother and baby’s actual needs. There is not, and there can never be, anything “baby friendly” about destroying the confidence of new mothers and making them feel guilty about a decision with trivial consequences.

A new paper raises the possibility that it isn’t only maternal confidence that is being killed. The paper is Deaths and near deaths of healthy newborn infants while bed sharing on maternity wards published earlier this year in the Journal of Perinatology.

It starts with the obvious. Bed sharing (co-sleeping) is known to be deadly to babies, and the risk is highest when mothers are impaired by drugs or alcohol:

Although bed sharing with infants is well known to be hazardous, deaths and near deaths of newborn infants while bed sharing in hospitals in the United States have received little attention … These events occurred within the first 24 h of birth during ‘skin-to-skin’ contact between mother and infant, a practice promoted by the ‘Baby Friendly’ (BF) initiative … We report 15 deaths and 3 near deaths of healthy infants occurring during skin-to-skin contact or while bed sharing on maternity wards in the United States. Our findings suggest that such incidents are underreported in the United States and are preventable. We suggest ways in which close maternal infant contact to promote breast feeding may be done more safely.

What factors contributed to these 15 deaths and 2 near deaths?

In eight cases, the mother fell asleep while breastfeeding. In four cases, the mother woke up from sleep but believed her infant to be sleeping when an attendant found the infant lifeless. One or more risk factors that are known or suspected (obesity and swaddling) to further increase the risk of bed sharing were present in all cases. These included … maternal sedating drugs in 7 cases; cases excessive of maternal fatigue, either stated or assumed if the event occurred within 24 h of birth in 12 cases; pillows and/or other soft bedding present in 9 cases; obesity in 2 cases; maternal smoking in 2 cases; and infant swaddled in 4 cases.

In other words, mothers were encouraged to keep babies in bed with them even though multiple modifiable risk factors for infant suffocation were present, including maternal impairment due to sedating drugs or exhaustion and soft bedding. Why? To encourage breastfeeding, of course.

The author notes:

… A stated aim of BF USA [US branch of the BFHI] is to ‘help mothers initiate breastfeeding within one hour of birth’… BF USA advises that infants and mothers share a room continuously and that infants be breast fed on demand without restricting the duration of the feeding and with a minimum of 10–12 feedings in 24 h. In addition United Nations Children’s Fund encourages in-hospital bed sharing. These recommendations will likely result in bed sharing for prolonged periods of time, particularly for mothers who have had cesarean sections or others, who do not wish to leave their beds frequently to breastfed.

As a result, hospitals have felt free to abolish well-baby nurseries, thereby reducing costs. An unholy alliance of lactivists and hospital administrators have conspired to force new mothers to keep babies with them at all times DESPITE the fact that we know that such behavior is not safe for babies.

An important question is: can in-hospital bed sharing be done safely? … In the United States, breastfeeding during bed sharing is regarded as safe so long as the mother is awake … The present and prior reports clearly show this is not the case during the immediate post-partum period. Frequent bed checks by nurses at 5–10 min intervals is advocated in the BF literature, but as deaths or injury can occur in a few minutes, such checks would have to become nearly continuous to entirely prevent death or injury.

How can we prevent these entirely preventable infant deaths?

When a mother is in close contact with her infant, one-on-one supervision of infant and mother should be undertaken by a person trained to monitor the infant’s wellbeing as well as the mother’s wakefulness. In many cases, nurses will be unavailable for these duties… In some cases, dedicated relatives or friends might perform this function. An alternative approach would be to electronically monitor infants (heart rate or arterial saturation) with alarms referred to the nursing station to avoid disturbing parents with false alarms. This would offer considerable protection for infants in close physical contact with mothers…

Or, here’s a radical thought: we could mandate well baby nurseries in all postpartum wards and allow mothers to send their babies to the nursery when they want to sleep!

It is long past time to reassess the “Baby Friendly” Hospital Initiative. Anything that kills babies CAN’T be baby friendly. It’s really the Lactivist Friendly Hospital Initiative since lactivists are the only ones who seem to benefit from forcing mothers to breastfeed and shaming and blaming them when they don’t.

When you frame an issue, you own an issue. Lactivists framed their personal desires as baby friendly. The truth is that efforts to force mothers to breastfeed are deadly, so we need to re-frame the issue. We must demand an end to the Baby Deadly Hospital Initiative or more babies will die entirely preventable deaths.

It’s seems its always the mother’s fault.

There is a long and storied history of mother blame extending back millennia. Women who couldn’t conceive were labeled “barren” even though infertility is caused by male factors 20% of the time. Women who had only daughters and no sons were blamed for the sex of their children, even though it is sperm that determine gender, not ova. For hundreds of years of recent history, women were told that their dreams could affect the outcome of pregnancy; dream of something frightening and the baby might be deformed. Within the past century, “refrigerator mothers” were blamed for autism even though there was never any evidence to support such a link.

Mother blame received impetus with the discovery of teratogens, chemical compounds (natural and synthesized) that do actually result in birth defects in offspring. Visions of teratogens (“toxins”) dance in the heads of many who care for pregnant women even though actual teratogens are rare. There is no question that alcohol (ethanol) is a teratogen in large amounts, but there’s nothing to justify the widespread hysteria over small amounts that is prevalent today.

The latest recruit to the deeply satisfying pastime of mother blame is epigenetics; all the scourges of old age in wealthy countries, like diabetes, obesity and cardiac disease, can be blamed on mothers changing the epigenetics of their offspring. No group has embraced this tactic with greater relish than natural childbirth advocates. The current favorite meme in the natural childbirth community is the claim that Cesarean sections cause epigenetic changes harmful to babies.

It’s not surprising that natural childbirth advocates seized on epigenetics with such enthusiasm. It is startlingly clear to anyone who bothers to look that modern obstetrics saves countless lives of mothers and babies each and every year. It’s pretty hard to oppose lifesaving interventions. But wait! What if those interventions caused health problems down the line? Then C-sections could be deemed harmful even if they saved lives.

Never mind that there’s absolutely no evidence than any maternal behaviors cause epigenetic changes. Mother blaming is too much fun to stop.

I’m not the only one who has noticed this.

In a recent edition of the journal Nature, seven scholars of history, philosophy, gender studies and population health offered a commentary entitled Society: Don’t blame the mothers. The authors identify the problem:

There is a long history of society blaming mothers for the ill health of their children… First recognized in the 1970s, fetal alcohol syndrome (FAS) is a collection of physical and mental problems in children of women who drink heavily during pregnancy. In 1981, the US Surgeon General advised that no level of alcohol consumption was safe for pregnant women. Drinking during pregnancy was stigmatized and even criminalized. Bars and restaurants were required to display warnings that drinking causes birth defects. Many moderate drinkers stopped consuming alcohol during pregnancy, but rates of FAS did not fall…

Until the nineteenth century, medical texts attributed birth deformities, mental defects and criminal tendencies to the mother’s diet and nerves, and to the company she kept during pregnancy.

Although it does not yet go to the same extremes, public reaction to developmental origins of health and disease (DOHaD) research today resembles that of the past in disturbing ways. A mother’s individual influence over a vulnerable fetus is emphasized; the role of societal factors is not. And studies now extend beyond substance use, to include all aspects of daily life.

The authors note that the scientific evidence to support mother blame by epigenetics is preliminary, weak, conflicting and inconclusive.

The authors offer four caveats when considering research on epigenetics:

… First, avoid extrapolating from animal studies to humans without qualification. The short lifespans and large litter sizes favoured for lab studies often make animal models poor proxies for human reproduction. Second, emphasize the role of both paternal and maternal effects. This can counterbalance the tendency to pin poor outcomes on maternal behaviour. Third, convey complexity. Intrauterine exposures can raise or lower disease risk, but so too can a plethora of other intertwined genetic, lifestyle, socio-economic and environmental factors that are poorly understood. Fourth, recognize the role of society. Many of the intrauterine stressors that DOHaD identifies as having adverse intergenerational effects correlate with social gradients of class, race and gender. This points to the need for societal changes rather than individual solutions. (my emphasis)

I’d like to offer a fifth caveat: Consider whether it even makes sense to implicate epigenetics.

Take the natural childbirth love affair with the epigenetic “risks” of C-sections. It reflects a fundamental misunderstanding of what epigenetics is and how it works.

Trans-generational epigenetic changes are heritable changes in the regulation of gene expression. The classic example is famine that leads to epigenetic changes that render individuals better able to survive during food scarcity. That improved ability can be passed on to children and grandchildren. The epigenetic changes can become harmful if the environment changes radically. The epigenetic change that allowed a grandfather to survive a famine might increase the risk of a daughter being obese.

That’s the way that epigenetic changes purportedly cause harm, although there is a serious problem with that argument. If epigenetic changes occur so easily, shouldn’t the granddaughter experience epigenetic changes that decreased the risk of obesity?

The bottom line is clear. At the moment, there is no reliable, reproducible scientific evidence that C-sections cause epigenetic changes. There’s no reason to think that C-sections would cause harmful epigenetic changes. There’s no reason to think that trans-generational epigenetic changes that caused harm to future generations wouldn’t change back.

While it is certainly possible for mothers to cause harm to unborn children (think thalidomide or excess Vitamin A ingestion), there is no evidence that  C-sections cause harm or that epigenetics has anything to do with it.

Yesterday I wrote about privilege and breastfeeding, incorporating insights from the chapter Managing the Lactating Body: The Breastfeeding Project in the Age of Anxiety by Orit Avishai.

I suspect that I am not the only one who was struck by the parallels between the breastfeeding project and birth birthing project so dear to the hearts of natural childbirth advocates. The attitude toward breastfeeding that Avishai ascribes to privileged women applies equally to childbirth.

According to Avishai:

I demonstrate that this group of women constructs the lactating body as a carefully managed site and breastfeeding as a mothering project – a task to be researched, planned, implemented and assessed, with reliance on expert knowledge, professional advice and consumption.

Here’s my conclusion about natural childbirth advocates:

Natural childbirth advocates construct the birthing body as a carefully managed site and childbirth as a mothering project – a task to be researched, planned, implemented and assessed, with reliance on expert knowledge, professional advice and consumption.

The birth project involves 4 critical tasks:

1. Consulting books and asking experts
2. Setting goals and assessing the product
3. Managing the uncooperative birthing body
4. Investing in the project

The irony is that this view of birth as a project to be managed is diametrically opposed to childbirth in nature, where childbirth, like any other bodily function, just happens. But the view of childbirth as a project serves the interests, financial and emotional, of those who promote that view.

Consider:

1. Consulting books and asking experts

If there is one thing that every natural childbirth advocate is absolutely, positively sure of it’s the idea that she has done her “research” and “educated” herself about childbirth. That’s because she has “consulted books and asked experts.” But, of course, she has done nothing of the kind. Obstetricians are the experts in childbirth and natural childbirth advocates generally ignore what they have to say. The natural childbirth advocate consults faux experts or experts in their own minds. She reads websites, books, blogs and message boards carefully curated to present an approved viewpoint and carefully monitored to delete any real scientific evidence. Natural childbirth “experts” are to birth what creationism “experts” are to evolution. They are quacks, cranks and laypeople who are so ignorant that they actually think they are knowledgeable.

The first step in the managing the birthing body, then, is not acquiring knowledge, it is indoctrination.

2. Setting goals and assessing the product

This, of course, is the real purpose of birth plans. Putting her plans in writing gives a women a way to determine if she has succeeded or failed at childbirth. The health of the baby is irrelevant; indeed the baby itself is irrelevant. The birth plan is about the project not the baby.

Years of experience, and a variety of scientific studies have demonstrated that birth plans are worse than useless.

Why?

• Most birth plans are filled with outdated and irrelevant preferences.
• Birth plans are gratuitously provocative.
• Birth plans have no impact on outcomes.
• Birth plans encourage unrealistic expectations. In fact, it appears that the birth plan may have actually set women up to be disappointed with their birth experience.

In the world of natural childbirth, the baby is not the goal, the fulfillment of the birth plan is the goal. Hence even the birth of a healthy baby after an uncomplicated labor can be a “failure” if the woman did not perform in the way that she specified in her birth plan.

3. Managing the uncooperative birthing body

In the world of obstetrics, managing childbirth complications is straightforward. The provider anticipates or diagnoses the problem, offers a treatment plan and successfully handles the complications.

It’s pretty straightforward in the world of natural childbirth, too, albeit very different. The provider denies the existence of the problem by claiming that it is a “variation of normal,” recommends wishful thinking (“trust” and birth affirmations), recommends idiotic “treatments” like chiropractic, herbs and supplements, and, when all else fails, blames the mother.

4. Investing in the project

Natural childbirth costs money. The pregnant woman must buy books, hire childbirth educators and doulas, and in the case of homebirth she must pay a midwife, buy a birth kit and rent a birth pool. Natural childbirth also costs tremendous psychic energy. She must “trust” and affirm, and be primed to argue with her caretakers if they don’t view the fulfillment of her birth plan as more important than the baby. She must also grapple with failure when, as is often the case, things do not go as planned. In the event that she is lucky enough to avoid complications, though, the payoff is that she can pretend that she is “empowered” by completing the project successfully.

Viewing childbirth as a project to be managed is only possible in a world of extraordinary privilege. It rests entirely on the notion that regardless of how absurd and unsafe the plans are, and no matter how close the mother comes to injuring or killing her baby or herself, obstetricians will successfully rescue them from her idiocy. Moreover, the idea that rejecting pain relief in labor is an achievement depends entirely on easy accessibility to pain relief. The same goes for the routine interventions of childbirth. You must have easy access to them in order to give meaning to rejecting them.

Hence natural childbirth is the province of Western, white, well off women. It has nothing to do with childbirth in nature as the millions of women forced to give birth in nature each year can tell you. Managing the birthing body is an affectation of the privileged. Everyone else merely hopes to survive.

Lactivism, like natural childbirth and attachment parenting, is a philosophy of privilege.

Specifically, privileged women shame the less privileged — women of lower socio-economic class and women of color — by insisting that their personal preferences are not merely normative, but actually morally superior.

Lactivism, in other words, is like driving a Volvo.

Sociologist Orit Avishai explores this issue in the chapter Managing the Lactating Body: The Breastfeeding Project in the Age of Anxiety. Avishai immediately gets to the heart of the matter:

Public health campaigns [to promote breastfeeding] are based on two premises: ‘the breast is best’ and breastfeeding as ‘natural’… [T]hese premises are flawed. Like other parenting, reproductive, health and lifestyle choices, breastfeeding is an option framed by access to resources, corporate interests, public policy, competing ideas about science, motherhood and standards of infant care. Drawing on interviews with class-privileged American mothers, this chapter sheds light on how breastfeeding is shaped at the crossroads of moralised motherhood, public health campaigns and grass-roots activism, economic disparities and the commercialised, medicalised and professionalised contexts that characterise contemporary parenting. Specifically, I demonstrate that this group of women constructs the lactating body as a carefully managed site and breastfeeding as a mothering project – a task to be researched, planned, implemented and assessed, with reliance on expert knowledge, professional advice and consumption. The construction of breastfeeding as a maternal project sheds light on breastfeeding disparities (‘successful’ breastfeeders tend to be white, educated, older and heterosexually partnered mothers) and on the fallacy of the ‘breast is best’ and ‘breastfeeding is natural’ slogans.

That goes a long way toward explaining why breastfeeding has been aggressively promoted in public health campaigns despite the fact that it has only trivial benefits. These campaigns have been motivated in large part by privileged white women inscribing and reinforcing their privilege by declaring their personal preferences morally superior to those of poor women and women of color.

It is well established that breastfeeding rates differ markedly by race and class. As Avishai notes:

… [B]reastfeeding has become even more stratified… [I]n Western nations breastfeeding has become a marker of privileged motherhood, where white, middle-class, educated, heterosexually partnered and older mothers are more likely to initiate breastfeeding, continue breastfeeding beyond the first few days and upon return to paid employment and breastfeed exclusively…

These disparities are also a product of racialised and sexualised public discourses. Blum argues that the ‘breast is best’ frame creates a standard of good mothering that faults mothers who cannot comply with this standard or do not wish to comply with it. These mothers are usually poor, uneducated and minority women, some of whom resist what they see as imposition of white, middle class mothering standards.

The heart of Avishai’s argument is that, contrary to the claims of lactivists, breastfeeding as practiced in contemporary America is not natural. Indeed:

…[T]he lactating body [is] a carefully managed site and breastfeeding [is] a ‘project’ – a task to be researched, planned, implemented and assessed. Analysis of the breastfeeding project demonstrates that breastfeeding is far from a natural practice.

Breastsfeeding as a project is promoted in part because of the commercialization of breastfeeding:

… [A] new profession – lactation consulting – emerged in the mid-1980s as an alternative to the free breastfeeding advice offered by La Leche League. Working within a clinical frame, this profession boasts formal training and certification procedures, a vibrant professional association, the International Lactation Consultant Association, and a peer reviewed journal. Breastfeeding is additionally supported by a vast market of goods and services, including lactation classes and books, nursing clothes, bras, pillows, chairs and breast pumps and related paraphernalia. Numerous websites also provide breastfeeding advice, support and merchandise.

What does managing the lactating body involve? Avishai conducted in depth interviews with first-time, educated, workforce- experienced and class-privileged mothers in the San Francisco Bay Area and created this list based on what she learned.

• Consulting books and asking experts
• Setting goals and assessing the product
• Managing the uncooperative lactating body
• Investing in production facilities

Each stage is mediated by privilege, and most require money. In contrast to the claims of lactivists, breastfeeding is no longer free.

Though most of the women in this study suggested that breast milk is produced by their bodies ‘free of charge’, and contrasted breastfeeding’s ‘simplicity’ with the ‘bagfuls of paraphernalia’ associated with bottle-feeding, many of them were immersed in breastfeeding-related consumption, reflecting broader consumption trends that characterise privileged parenthood. Since the physiology of lactation assumes proper levels of nourishment and rest as well as maternal health – all stratified in the United States – the very construction of breast milk as ‘free’ by mothers and lactation experts masks social inequalities. In addition, … participants in my study embraced the expanding market of nursing gear, gadgets and accessories. They invested in nursing bras (∼ $40), nursing pads, breast pumps and related kits ($200–400), nursing pillows (∼ $40) and nursing chairs (∼$200). Some purchased herbal supplements to enhance their milk supply
or acquired breastfeeding outfits.

Avishai concludes:

Analysis of the mothering project sheds light on the obstacles encountered by women who cannot mobilise such resources, which are no longer considered optional. Viewed in this light, the twin constructs of ‘the breast is best’ and ‘breastfeeding is natural’ are impoverished slogans that do not capture the extent to which both the science and the imagery of breastfeeding are shaped by normative assumptions and middle-class experiences.

Although Avishai describes contemporary lactivism through the lens of sociology, her analysis is nearly indistinguishable from what I have been writing for years:

The benefits of breastfeeding in industrialized countries, while real, are trivial.
The public health campaigns that currently exist are not justified by the empirical benefits of breastfeeding.
Lactivism is the attempt by privileged white women to inscribe and reinforce their privilege by shaming women who are not like them.
Efforts to ban formula gift bags, lock up formula, and make women sign breastfeeding contracts are further signs of privilege and attempts at shaming.
Breastfeeding is NOT best for all mother and babies.

Or to put is in a slightly different way, breastfeeding is equivalent of driving a Volvo. It’s a mark of race and class that provides marginal benefits but serves as a visible sign of privileged status.

It’s an exquisitely calibrated feedback system of supply and demand. Regularly challenge the organ by removing the amount needed and the organ makes more.

But what if the organ doesn’t make enough? Will the amount produced increase if we challenge the organ more frequently?

Think I’m talking about the breast and pumping? I’m not. I’m talking about the pancreas and classic, juvenile onset (type I) diabetes.

Diabetes (type I) is characterized by a failure of the pancreas to produce the amount of insulin needed. Although blood sugar regulation is meant to be an exquisitely calibrated system of supply and demand, with more insulin produced and released when the body faces a large sugar challenge, it doesn’t work that way in classic diabetes. The pancreas can’t produce more insulin regardless of the stimulus and ingesting ever larger amounts of sugar won’t stimulate the pancreas to produce more insulin; it will simply result in diabetic coma.

Reflecting on the fact that the feedback system of insulin and blood sugar fails utterly in classic diabetes made me wonder whether it makes any sense to imagine that pumping will do anything to increase inadequate breastmilk supply. I can’t find any scientific evidence that it does.

What causes failure of lactogenesis? According to this paper by lactation consultant Nancy Hurst Recognizing and Treating Delayed or Failed Lactogenesis II:

Although actual rates of failed and delayed lactogenesis are unknown, estimates ranging from 5% to 15%, respectively, have been reported.

It’s not a rare problem; it’s a common one.

Delayed lactogenesis II denotes a longer than usual interval between the colostrum phase and copious milk production, but whereby the mother has the ability to achieve full lactation. Failed lactogenesis II is a condition wherein the mother is either able to achieve full lactation but an extrinsic factor has interfered with the process, or one or more factors results in failure to attain an adequate milk production. Failed lactogenesis can be described further in the context of two types of conditions: a primary inability to produce adequate milk volume, or a secondary condition as a result of improper breastfeeding management and/or infant-related problems.

When the problem is a result of improper breastfeeding technique or infant inability to suck properly, pumping can improve the problem because the underlying feedback system of supply and demand is intact. But what if the problem is a failure of the breast to produce enough milk? That failure can be caused by:

… anatomic breast abnormalities or hormonal aberrations. Insufficient mammary glandular tissue, postpartum hemorrhage with Sheehan syndrome, theca-lutein cyst, polycystic ovarian
syndrome, and some breast surgeries have been implicated as possible causes of lactation failure.

Hurst recommends the following treatment plan for both primary and secondary failure to produce adequate breastmilk:

A treatment plan for a delay or suspected lactation failure should include the following key elements: providing adequate infant nutrition, maximizing breast stimulation and complete breast emptying, strategies to measure milk intake during breastfeeding, … and recognition of when maternal lactation potential is reached.

Note that providing adequate infant nutrition is the FIRST step to any treatment plan. Hurst emphasizes that increasing the number of breastfeeding sessions is NOT going to solve the problem. Supplementation may be required.

Determining the need for supplementation is essential in promoting adequate infant growth and energy levels. An infant who is malnourished will not have the energy to breastfeed effectively; recommending that the mother simply increase the number of breastfeeds per day to improve her milk volume and the infant’s milk intake will not improve the situation when failed lactogenesis II is suspected.

How about pumping:

Mechanical breast pumping with an effective hospital-grade breast pump following each breastfeeding should be initiated whenever a delay or failed lactogenesis is suspected. This practice serves to increase breast stimulation and promote complete breast emptying.

That should help if the problem in related to breastfeeding technique or poor infant feeding, but what’s the evidence that pumping will improve output in women with primary failure of lactogenesis?

There is no evidence that pumping improves breastmilk supply in primary failure of lactogenesis. No only is there no scientific evidence to support the recommendation of pumping, as far as I can determine, no one has even studied the issue. If anyone else is aware of any evidence, please share it.

Yes, pumping increases supply in women who have an intact hormonal feedback system of supply and demand. But if the problem is failure of supply, why would demanding more have any impact at all? It is unreasonable (and deadly) to imagine that feeding ever larger amount of sugar to a diabetic will stimulate insulin production. It seems unreasonable (and potentially deadly for an infant) to imagine that pumping more and longer is going to stimulate breastmilk production.

Last week I noted that telling a new mother to breastfeed AND pump is barbaric. I pointed out that the key to a health, happy, thriving infant is a physically and emotionally healthy mother. That means a mother who is getting enough rest, whose mental health needs are being addressed, and who is able to enjoy substantial amounts of time happily bonding with her child. Breastmilk is not necessary, not necessarily best for every mother-infant dyad, and the effort to produce it is positively harmful in some situations.

So lactation consultants telling new mother with primary lactogenesis to pump in addition to breastfeeding is not only barbaric, but also completely ineffective.

Way to go, lactation consultants.