Nearly all studies on the purported benefits of breastfeeding over formula feeding are meaningless.

Why?

Because the choice of the comparison groups is beset by a disabling flaw.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Babies who were breastfed but failed to thrive must be placed in the breastfeeding group, NOT the formula group.[/perfectpullquote]

Nearly all breastfeeding studies compare two groups of infants, those that have been breastfed and those that have not. Babies who were breastfed but failed to thrive are inappropriately placed in the formula feeding group, instead of the breastfeeding group where they belong.

To understand why that’s a critical problem, it helps to consider another example.

Imagine we are trying to determine the risks of homebirth. We can’t simply compare death rates of babies born at home to death rates of babies born in the hospital. That would lead to an erroneous outcome since many women who develop complications during homebirth are transferred to the hospital where the baby is ultimately born.

If we looked only at place of birth at the moment of delivery, we would erroneously include the homebirth complications in the hospital group. Homebirth would end up looking much safer than it is in reality. The appropriate comparison is women who intend to give birth at home and women who intend to give birth in a hospital.

How does that apply to breastfeeding studies?

Most breastfeeding studies compare babies who are breastfed with babies who are not breastfed at a moment in time weeks or months after birth (3 months, 6 months, one year). But when we only look at breastfeeding status at a particular moment in time, babies who develop complications from breastfeeding will mistakenly end up in the formula group. The appropriate comparison is women who intend to breastfeed and women who intend to formula feed.

If we want to know the difference between babies who are breastfed and those who are formula fed, we must place the babies who failed to thrive on breastfeeding in the breastfeeding group, NOT the formula group.

Sure, successful breastfeeding might be beneficial compared to formula feeding, but that’s something entirely different than claiming that breastfeeding is better than formula feeding. The truth could be the opposite: that when compared to breastfeeding (both successful AND unsuccessful), formula feeding is not merely beneficial, it is life saving. And, therefore, many mothers who are formula feeding are doing so because of the extraordinary benefits of formula.

The bottom line?

Studies that compare breastfeeding to formula feeding but put breastfeeding failures into the formula feeding group suffer from a disabling flaw that makes their results meaningless. In other words, nearly the entire literature that claims to show that breast is best shows nothing of the kind!

Natural childbirth advocates like to say that “there’s more to birth than a healthy baby.” Duh! No one ever said otherwise. That’s why epidurals and maternal request C-sections should be available to anyone who wants them. They’ve chosen a specific birth experience because there’s more to birth than a healthy baby; there’s pain relief and avoiding pelvic trauma among other things.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Where did this mother get the idea that the obstetrician wants to ruin her birth experience?[/perfectpullquote]

But a dead baby will ruin your birth experience every time.

Consider this post from a natural childbirth Facebook group:

Well, fired my doctor yesterday. I am currently 40+6.
I’m comfortable, healthy, perfectly fine. Baby is comfortable, healthy, perfectly fine.
But, according to my doctor, “at this point, it is pitocin or a c section” and I “need to just get used to the idea of pitocin”
She informed me she was stepping out to call L&D to schedule an induction, I got dressed and left.
I understand her games, and I’m not playing. She has never spoken to me this way and up until the point-made me believe she was supportive of my natural birth preferences. I have an amazing support team and doula. We are all on the same page.

Baby will come when baby is ready

Sure the baby will come eventually; it just might be dead when it arrives. And let me assure you, a dead baby will ruin your birth experience!

Preventing dead babies is the job of every obstetrician. It is hardly a game; it’s a sacred trust.

Where did this mother get the idea that the obstetrician wants to ruin her birth experience? From natural childbirth advocates, the same people who created the cultural construct of “birth experience.”

The conceit of the contemporary natural childbirth movement is that they are recapitulating birth in nature. Nothing could be further from the truth. In nature, a good birth experience was and remains a healthy baby born to a healthy mother.

Caroline Bledsoe and Rachel Scherrer are anthropologists who study the natural childbirth movement. In the chapter The Dialectics of Disruption: Paradoxes of Nature and Professionalism in Contemporary American Childbearing they explain the cultural construct of natural childbirth:

… As childbearing became safer and more benign visions of nature arose, undesired outcomes of birth for women came to consist of a bad experience and psychological damage from missed bonding opportunities. Today, with safety taken for granted, the new goal has become in some sense the process itself: the experience of childbirth…

The mother refusing induction is taking the safety of her baby utterly for granted. She doesn’t know that every day beyond 39 weeks increases the risk of stillbirth.

Does that mean her baby is guaranteed to die? No, it means the risk of the baby dying is increased. It’s like refusing to put a baby in a car seat on a trip to the supermarket. The odds that the baby will die on the trip are small … but refusing to use a car seat makes them much higher than they would have been. The odds that this baby will die are also small, but by refusing a medically recommended induction the mother has made them much higher.

Bledsoe and Scherrer offer a critical insight into the thinking of mothers like these:

If nature is defined as whatever obstetricians do not do, then the degree to which a birth can be called natural is inversely proportional to the degree to which an obstetrician appears to play a role. The answer to why obstetricians are described with such antipathy thus lies not in the substance of what obstetricians do that is unnatural – whether the use of sharp incision. forceps, and medications that blunt sensation. or anything else- but in the fact that obstetricians represent a woman’s loss of control over the birth event.

…[I]t is not what obstetricians do that women find problematic but the fact that they are the people who step in when the woman is seen to have failed.

This mother hired her obstetrician, because she believed the obstetrician would keep her and her baby safe. But when the OB recommended induction, the mother rejected it because it embodied “failure” on her part. She failed to go into labor on her own.

Bledsoe and Scherrer understand what the mother does not:

… As we turn to the disruptions that preoccupy US middle-class women as they contemplate the birth of a child. it is vital to keep in mind both the dangers that reproduction can entail and the science that has allowed us to imagine as common sense a safe, uninterrupted, reproductive life trajectory.

Because there’s nothing like a dead baby to ruin a birth experience!

It’s confusing.

The UK, with an elaborate system for studying maternity care, publishes reams of statistics about stillbirths, perinatal mortality, infant mortality and maternal mortality through MBRRACE-UK, Mothers And Babies: Reducing Risk through Audits and Confidential Enquiries. Here’s the latest publication UK Perinatal Deaths for Births from January to December 2017.

In 266 pages, with dozens of tables and charts, they slice and dice the mortality statistics in a thousand different ways: by ethnicity, by socio-economic status, by hospital system, by post code. Yet there’s one critical statistic that is missing: death rates at home birth. In fact, I’ve been writing about homebirth in the UK since 2006, but to my knowledge the UK has hidden their homebirth death rates the entire time.

Why? It might have something to do with the fact that the government began promoting homebirth aggressively BEFORE they could show that homebirth was safe. The key study of UK homebirth, the Birthplace Study, began years AFTER the government promotion efforts.

Indeed, a cynical person might wonder if perhaps the statistics from UK homebirths that were occurring before the Birthplace Study showed that homebirth has an increased risk of perinatal death and the government was desperately searching for some way to make homebirth appears as safe as hospital birth.

It might have something to do with the fact that back in 2006, NICE (the National Institute for Clinical Excellence) reviewed the existing homebirth literature and concluded that homebirth increases the risk of perinatal death.

The report was quoted in The Telegraph, June 2006 before it was officially published:

Birth outside a [physician] led unit is consistently associated with an increase in normal vaginal births, an increase in women with an intact perineum and an increase in maternal satisfaction…

The only other feature of the studies comparing planned births outside [physician] units is a small difference in perinatal mortality … Our best broad estimate of the risk is an excess of between 1 death in a 1000 and 1 death in 5000 births. We would not have expected to see this, given that in some of the studies the planned hospital groups were a higher risk population.

But the government wanted to promote homebirth and exerted pressure on NICE to change the report.

From The Telegraph, July 2, 2006:

Nice’s draft guidance, which included a recommendation for all pregnant women to be told of a “trend towards a reduction in perinatal mortality” in hospitals, was submitted to the Department of Health nearly a fortnight ago.

Several days later – and ahead of its publication on June 23 – it was altered by Andrew Dillon, chief executive of Nice, after concerns were raised by the Department of Health. To the fury of his own experts, who felt that their message was being diluted, the wording was changed to: “There may be a risk of lower perinatal mortality” in hospital.

Think about that: in an effort to promote homebirth, the government suppressed the opinion of its experts that homebirth increases the risk of perinatal death.

The Birthplace Study itself was hardly the unalloyed success they were hoping for. The authors found that homebirth increases the risk of death, brain damage and serious neonatal injury.

They evaluated the results by creating a composite index of poor outcomes: intrapartum stillbirths, early neonatal deaths, neonatal encephalopathy [brain damage] meconium aspiration syndrome, brachial plexus injury, and fractured humerus or clavicle. Using this measurement:

… [T]here was a significant excess of the primary outcome in births planned at home compared with those planned in obstetric units in the restricted group of women without complicating conditions at the start of care in labour. In the subgroup analysis stratified by parity, there was an increased incidence of the primary outcome for nulliparous women in the planned home birth group (weighted incidence 9.3 per 1000 births, 95% confidence interval 6.5 to 13.1) compared with the obstetric unit group (weighted incidence 5.3, 3.9 to 7.3).

In other words, the risk of death and serious injury was nearly double in the homebirth group and that increase was seen mainly among first time mothers. Moreover, the criteria for inclusion in the study were far stricter than the actual UK criteria for homebirth. Only the lowest risk women were included in the study despite the fact that higher risk women are eligible for homebirth.

The Birthplace Study fails to answer the most important question that women have about homebirth: does homebirth AS PRACTICED in the UK increase the risk of perinatal death. That information is undoubtedly available. A government that tracks perinatal death rates by ethnicity, socio-economic status, health system and post code can track perinatal death rates by whether or not a birth was a planned homebirth.

So why is the UK hiding their homebirth death rate? I suspect that it’s because the government fears (or knows) that homebirth in the UK increases the risk of perinatal death substantially, even more than what the Birthplace Study shows.

It is a sad fact that women are the biggest fans by far of contemporary charlatanism. It’s true for astrology and tarot cards, and equally true for health quackery like reiki and homeopathy.

In the paper The appeal of medical quackery: A rhetorical analysis, pharmacists Widder and Anderson note that believers in quackery are likely to be female, spiritual, with lower perceived health and a “holistic” view of health problems.

Why do so many women embrace quackery?

The currently favored explanation is because healthcare providers have been notoriously unsympathetic to women’s health issues. That explanation is advanced by everyone from quack defenders like Jennifer Block:

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Belief in quackery has been RISING at the same time medicine has been taking women’s symptoms and suffering more seriously.[/perfectpullquote]

When we become empowered to learn more about our bodies, our instincts, our emotional landscapes and the connections therein, maybe we’ll begin to demand that our complex and (still!) mysterious physiologies are treated with respect, dignity, and humility in the realms of medicine and science.

to physicians fighting quackery like cardiac surgeon Nikki Stamp who wrote Gwyneth Paltrow’s ‘Goop Lab’ is horrible. The medical industry is partly to blame. in yesterday’s Washington Post.

…[M]edicine as a profession and a science has no doubt played a part in the genesis and growth of big wellness. For virtually the whole of its existence, medicine has disenfranchised women and, to varying degrees, continues to do so. Even as medicine has modernized with an emphasis on autonomy and resolving bias, it remains, at times, paternalistic and patriarchal.

But what if there’s another reason altogether? Perhaps women’s embrace of quackery is a direct results of their lack of education in math and science.

Don’t get me wrong; I’m NOT arguing that medicine is perfect. I’m well aware that there is a long and ugly history of medical paternalism in which women’s symptoms, pain and suffering have been ignored. But belief in quackery has been RISING in parallel to decreases in that paternalistic attitude.

Women now represent half of entering medical school classes and far more than half of physicians in fields like gynecology and pediatrics. Women are taking a greater role overall in the delivery of healthcare as a result of a rise in nurse practitioners and midwives. If belief in quackery were truly a response to practitioners who don’t understand and don’t care about women’s health concerns, it should be falling in the early 21st Century, not rising.

Perhaps women embrace healthcare quackery — and “other ways of knowing” — not because they are being ignored by mainstream providers, but because they don’t understand and therefore fear math and science.

Consider the issue of vaccinations. What do you need to know to understand the science around vaccines? In addition to education in immunology, you need a good grasp in three areas: the scientific method, statistics and logical thinking. Education and training in STEM (science, math, engineering and tech) provide students with a strong foundation in science, statistics and logical thinking and women are notoriously underrepresented in STEM

It’s no wonder then that women who lack grounding in science, statistics and basic logic imagine that the case for vaccines is nothing more than accepting the authority of experts. There is literally no way for them to apprehend the real arguments for the safety and efficacy of vaccines beyond taking someone else’s word for it. In truth, anti-vaxxers are more likely to be “sheeple” than the pro-vaxxers they criticize; they simply rely on favored quacks like Andrew Wakefield rather than legitimate scientists because they can’t tell the difference.

There’s another reason why women embrace healthcare quackery. Many healthcare quacks are women. Science is hard and quackery is easy. Scientific professions require rigor; quack professions require only credulousness. It’s hard to be a pharmacist; it’s easy to be an herbalist. It’s hard to be an orthopedic surgeon; it’s easy to be a chiropractor. It is much harder to become a physician than a nurse. It also a lot harder to be an obstetrician than to be a midwife. That’s reflected in the fact that physicians are far less likely than midwives and nurses to be taken in by and become purveyors of quack theories and remedies.

Maybe the solution to the current epidemic of belief in quackery is one that we should be pursuing in any case: encouraging and facilitating an increase of women in science, math, engineering and technology!

What do you do when you desperately want to believe in something and there is no scientific evidence to support it? You call it “other ways of knowing”!

What do other ways of knowing look like in practice?

They look like this:

Including the nonrational is sensible midwifery, by Jenny A. Parratt, and Kathleen M. Fahy, was published in the Australian midwifery journal Women and Birth. It has a simple premise and conclusion: many principles of radical midwifery theory are not supported by science. Rather than modify midwifery theory to reflect scientific knowledge, it is easier (and more lucrative) to rationalize ignorance and superstition by calling it other ways of knowing.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]“Other ways of knowing” rationlize ignorance and superstition.[/perfectpullquote]

It is striking how the language of the paper resembles that used in justifications of religious belief, the most popular of all “other ways of knowing”:

Much of life cannot be apprehended or comprehended on a purely rational basis… Consider, for example, the sensations that may arise when watching a sunset, hugging a loved one, hearing a bird’s song or delighting in a sense of bodily capability… Similarly a midwife’s ordinary practice of being with the woman can be experienced by the midwife in quite extraordinary — nonrational — ways…

The centrality of emotion is similar; beliefs that are not supported by scientific evidence are nevertheless valid because they help people feel better about themselves; interestingly, the “people” in question are not necessarily patients; they can also be practitioners or purveyors.

Experiencing the nonrational may include sensations of inner power and/or inner knowing… These experientially grounded, nonrational aspects of life have been described variously as mysterious, sacred, spiritual and intuitive… Experiences that are nonrational are experiences of unity and wholeness; …

And, of course, no discussion of other ways of knowing is complete with reference to the “soul”.

Our soul is our own particular organic expression of the spiritual milieu of nonrational power. The soul moves in parallel with spirit: thus soul is nonrational, ethically neutral and idiosyncratic… Through our soul we may interpret and experience the power of spirit in diverse and contrasting ways: e.g. liberating, oppressive, joyous, peaceful or challenging…

The central claim of the paper is that the inclusion of the non-rational is midwifery “enhances safety”, although the authors’ explanation seems to show nothing of the kind.

When the concept of ‘safety’ is considered in childbearing it can illustrate how insensible rationality can be and how negative consequences can occur. Safety is an abstract concept because it is difficult to define and can only be considered in general terms. Rational dichotomous thought, however, provides ‘safety’ with the following defining boundaries:
– ‘safe’ has a precise opposite called ‘unsafe’,
– every situation/person/thing must be either be safe or unsafe,
– a situation/person/thing cannot be both safe and unsafe,and
– it is not possible for a situation/person/thing to be anything
other than safe or unsafe.

The authors complain:

…What is deemed as safe is aligned with what is rational and what is unsafe is aligned with what is irrational. As irrationality is not acceptable this essentially forces the definition of safety to be thought of as ‘true’ even though it may not fit with personal experience and all situations…

For example:

…[W]hen a woman and midwife have agreed to use expectant management of third stage, but bleeding begins unexpectedly, the expert midwife will respond with either or both rational and nonrational ways of thinking. Depending upon all the particularities of the situation the midwife may focus on supporting love between the woman and her baby; she may call the woman back to her body; and/or she may change to active management of third stage. It is sensible practice to respond to in-the-moment clinical situations in this way… Imposing a pre-agreed standard care protocol is irrational because protocols do not allow for optimal clinical decision-making which requires that we consider all relevant variables prior to making a decision. In our view all relevant variables include nonrational matters of soul and spirit.

Evidently, even if the woman bleeds to death for lack of pitocin, the decision to “support love between the woman and her baby” is still the correct one because her “soul” is “safe”.

The authors conclude:

Being open to the nonrational in midwifery practice makes room for midwives to self-reflexively acknowledge aspects of themselves, such as their fears, in a way that does not interfere with their practice. During birth, making room for the nonrational broadens both midwives’ and women’s knowledge about trust, courage and their own intuitive abilities including the changing capabilities of bodies….

At least these midwives are honest, even if completely inane. A fundamental (perhaps, the fundamental) goal of other ways of knowing is to make purchasers and purveyors feel good about themselves. Coming face to face with the fact their cherished beliefs in homeopathy, anti-vax or radical midwifery are nothing more than ignorance and superstition makes believers feel badly about themselves.

Fortunately, there is a way for purchasers and purveyors of ignorance and superstition to feel better. Just call the beliefs other ways of knowing!

A piece in today’s Guardian asks the intriguing question: Is breastfeeding incompatible with American capitalism?

And while it reaches the right answer — yes, it is incompatible — it fails to note the right reason: breastfeeding is promoted so aggressively precisely BECAUSE it is incompatible with capitalism. La Leche League, the engine of contemporary lactivism, was started with the express intent of keeping women out of the workforce.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]La Leche League, the engine of contemporary lactivism, was started with the express intent of keeping women out of the workforce.[/perfectpullquote]

Journalist Brianna Bell compares what she was told about breastfeeding to the reality of breastfeeding.

…B]reastfeeding … was not as cost-effective as I had first believed…

There’s also an unspoken cost that many breastfeeding proponents neglect to mention: the cost of a mother’s time…

And that’s time that is taken away from paid work, forcing many women to choose between breastfeeding and working. There’s no contest since most women who work cannot survive without the income it provides.

The solution seems obvious to Bell: paid maternity leave.

I’m strongly supportive of paid maternity leave because both babies and mothers benefit from it. But there are two reasons why it is not the solution.

First, Bell fails to consider that the country with the LOWEST rate of breastfeeding in the world is the UK and it has a system of generous maternity leave. Would more women in the US breastfeed for longer if we had such a system? There’s no reason to think so.

Second, breastfeeding is promoted as aggressively as it is NOT because its benefits; in industrialized countries the benefits of breastfeeding are trivial. (Don’t believe me? The UK, the country with the lowest breastfeeding rate in the entire world, has one of the lowest infant mortality rates in the world.) It is promoted as aggressively as it is because contemporary lactivism is intended SPECIFICALLY to keep mothers out of the workforce.

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

In the book La Leche League: At the Crossroads of Medicine, Feminism, and Religion, Jule DeJager Ward explains:

[A] central characteristic of La Leche League’s ideology is that it was born of Catholic moral discourse on family life … The League has very strong convictions about the needs of families. These convictions are the normative heart of its narrative …The League’s presentations and literature carry a strong suggestion that breast feeding is obligatory. Their message is simple: Nature intended mothers to nurse their babies; therefore, mothers ought to nurse.

In the late 1950’s when LLL was founded, its members believed that if they forced women to choose between working outside the home vs. breastfeeding as “best” for their babies, mothers would choose breastfeeding. That may have been what happened in the beginning but for at least the last 40+ years, when forced to choose between working and breastfeeding, most women chose working.

That’s why lactivists persist in grossly exaggerating the benefits of breastfeeding far beyond anything supported by the scientific literature. That’s why they dream up ever more arcane “benefits” of breastfeeding (the microbiome! epigenetics!) as the substantive benefits are systematically debunked. And that’s why they have made breastfeeding ever more onerous: refusing to supplement, promoting bedsharing — a practice deadly to babies — and normalizing maternal exhaustion

These onerous restrictions dovetail with LLL’s original mission, to force women to choose between breastfeeding and working. The last thing lactivists want is to make it possible for women to do both. That’s why it is going to be a very long time before the US adopts universal, extended, paid maternity leave.

Breastfeeding as promoted by contemporary lactivists is incompatible with American capitalism … just it was designed to be!

The New York Times Op-Ed Who’s Afraid of Gwyneth Paltrow and Goop? by Elisa Albert and Jennifer Block is offensive for a variety of reasons.

It’s offensive because it is another example of a prestigious news outlet publishing alternative “facts.” It’s offensive because it sugar coats the rabid consumerism promoted by a profit driven corporation. And its claim that pseudoscience is feminist is particularly offensive to women because it is an insult to the memory of famous women scientists who struggled against the misogynistic belief that science and math are “too hard” for women and they are reduced to relying on intuition.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Women are just as smart as men, as mathematically gifted as men, and as capable of SCIENTIFIC reasoning as men.[/perfectpullquote]

This passage in particular devalues the women scientists and mathematicians who struggled against the suffocating misogyny of beliefs about women’s intelligence or lack thereof:

Throughout history, women in particular have been mocked, reviled, and murdered for maintaining knowledge and practices that frightened, confused and confounded “the authorities.” (Namely the church, and later, medicine.) Criticism of Goop is founded, at least in part, upon deeply ingrained reserves of fear, loathing, and ignorance about things we cannot see, touch, authenticate, prove, own or quantify. It is emblematic of a cultural insistence that we quash intuitive measures and “other” ways of knowing — the sort handed down via oral tradition, which, for most women throughout history, was the only way of knowing…

Seriously?

That’s an insult to the memory of Ada Lovelace whose mathematical feats laid the groundwork for the computer industry. Lovelace is known for her work on Charles Babbage’s Analytical Engine, publishing the first algorithm for use with the machine. She is rightly remembered as one of first computer programmers.

Lovelace encountered prejudice NOT because she resorted to feminine ways of thinking but because she dared master mathematics, a discipline that had been considered masculine.

It’s an insult to the memory of Marie Curie, the first woman to win a Nobel prize, the first person to win two Nobel prizes and the first person to win Nobel prizes in two different fields. She developed the theory of radioactivity, techniques to isolate radioactive isotopes and discovered two radioactive elements.

Curie encountered prejudice NOT because she resorted to feminine ways of thinking but because she dared master physics, a discipline that had been considered masculine.

It is an insult to the memory of Virginia Apgar. She developed the ubiquitously used Apgar score and is considered a pioneer in anesthesiology, teratology and neonatology.

Apgar encountered prejudice NOT because she resorted to feminine ways of thinking but because she dared master medicine, a discipline that had been considered masculine.

It is an insult to the memory of Rosalind Franklin whose pioneering efforts in deciphering the structure of DNA were hidden by men who couldn’t bear the thought that women were as capable of performing ground research as men.

Franklin encountered prejudice — and was nearly erased from the history books — NOT because she resorted to feminine ways of thinking but because she dared master X-ray crystallography, a discipline that had been considered masculine.

It is an insult to the memory of Frances Oldham Kelsey, one of the first women at the FDA (Food and Drug Administration) who subsequently was awarded the Presidential Award for Distinguished Service for refusing to back down from her insistence that thalidomide caused birth defects despite tremendous pressure from drug companies.

Kelsey encountered prejudice NOT because she resorted to feminine ways of thinking but because she dared to used science to refuse the importuning of the pharmaceutical industry, a profession that had been considered masculine.

But most of all, pretending that pseudoscience is feminist is insulting — and harmful — to the rising generation of women. We have enough trouble recruiting women into science, engineering and technology without other women insisting that all three are the purview of men and women should stick to “other ways of knowing.”

When we were children, my generation was told that science and math were “too hard” for women, and girls were steered away from physics and engineering toward professions like teaching and nursing. Women like me owe a deep debt to feminist pioneers who, often at great personal cost, paved the way for acceptance of women into every subject of study and every possible career.

They insisted — in the face of tremendous male resistance — that women are just as smart as men, as mathematically gifted as men, and as capable of conducting scientific research and making scientific discoveries as men. It is deeply insulting to their memories when women like Albert and Block portray science as male and pseudoscience as feminist.

It pretends to be transgressive but it promotes a thoroughly capitalist, rabid consumerism.

Because it’s really about money.

It venerates romanticized “traditional” wellness practices that not only were never practiced by our foremothers, but are thoroughly modern.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]In defending GOOP, Block and Albert imagine themselves as feminists, but they are fools fronting for a marketing machine.[/perfectpullquote]

Because it’s really about money.

It stresses feminist empowerment by perpetuating the misogynist belief that irrational thought is the special province of women.

Because it’s really about money.

It’s Gwyneth Paltrow’s GOOP and it’s pseudoscience in a dress, albeit a Prada dress.

That’s why it’s particularly delicious to read Who’s Afraid of Gwyneth Paltrow and Goop? by Elisa Albert and Jennifer Block, two privileged white women who defend the sacred right of another privileged white woman to defraud consumers. They imagine themselves as feminists when they are nothing more than fools, fronting for a marketing machine.

GOOP is a corporation devoted to profit and it profits by promoting conspicuous consumption of luxury products to wealthy women. Why is it being criticized by mainstream physicians and scientists? Because it makes false, unscientific and often fabricated claims about those products.

Because it’s really about money.

Albert and Block are astoundingly credulous. To read their piece you wouldn’t know that GOOP exists to sell products and is being criticized because their products not only don’t work as advertised, but literally can’t work as advertised.

Block and Albert plaintively ask:

So what underlies all the overwhelming, predictable, repetitive critiques? What exactly is so awful about a bunch of consenting adults seeking self-knowledge, vitality and emotional freedom?

They mobilize the tired tropes of radical feminism to defend a bastion of capitalism, a traditionally patriarchal economic system.

Throughout history, women in particular have been mocked, reviled, and murdered for maintaining knowledge and practices that frightened, confused and confounded “the authorities.” (Namely the church, and later, medicine.) Criticism of Goop is founded, at least in part, upon deeply ingrained reserves of fear, loathing, and ignorance about things we cannot see, touch, authenticate, prove, own or quantify.

No, throughout history women have been mocked, reviled and murdered for daring to expect the same rights and privileges as men. It had nothing to do with their “knowledge” and everything to do with the naked abuse of power that is misogyny.

Block and Albert mobilize the tropes of religion to undercut science, promoting the same arguments used by flat-earthers and creationists that belief is equal to science.

Our society likes to conjoin the concepts of science and health, but the two do not always overlap. Peer-reviewed, lab-generated, randomized, controlled, double-blinded evidence will always be the gold standard, but such studies aren’t always fundable, or ethical.

They mobilize New Age nonsense to promote traditional profiteering:

But it’s condescending to suggest that if we are interested in having agency over our bodies, if we are open to experiencing heightened states of awareness and emotion, if we are amazed by and eager to learn more about the possibilities of touch and intention and energy, and if we’d like to do everything within our power to stay out of doctors’ offices, we are somehow privileged morons who deserve an intellectual (read: patriarchal) beat-down…

But buying luxury products from GOOP is not asserting agency over your body; it’s allowing Gwyneth Paltrow agency over your wallet.

Because it’s really about money.

But I suspect that Albert and Block know that; they sell pseudoscience through their writing and for them, as for Paltrow, it all about the money.

The US maternal mortality rate has become a scandal. Too many women, particularly women of color, die of pregnancy related causes or in the year after giving birth.

But a comparable scandal, in my view, is how we let maternal mortality rise so high. We deliberately ignored the actual data about maternal mortality in favor of a conventional wisdom that blamed C-sections rates, obstetric technology and obstetricians.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]We ignored the actual data about maternal mortality in favor of a conventional wisdom that blamed C-sections rates, obstetric technology and obstetricians.[/perfectpullquote]

A new report from the CDC, Evaluation of the Pregnancy Status Checkbox on the Identification of Maternal Deaths, confirms the scandalous truth.

An article from CBS explains the findings:

Maternal mortality is much higher among black women.

The maternal death rate among black women was 37.1 deaths per 100,000 live births, a rate up to three times the rates for non-Hispanic white and Hispanic women, the report said.

Maternal mortality is not, by and large, a problem of death in childbirth; it’s a problem of women dying AFTER being discharged from the hospital.

Maternal mortality is not a problem of pregnancy complications; it’s a problem of pre-existing chronic conditions exacerbated by pregnancy.

Heart disease and stroke caused more than 1 in 3 pregnancy-related deaths between 2011 and 2015 in the United States, according to the CDC.

Maternal mortality reflects the increasing age of pregnant women.

The data also showed the maternal death rate among women 40 and older was 81.9 deaths per 100,000 live births, almost eight times the number for women under 25.

Maternal mortality has NOT been rising precipitously as has been claimed repeatedly. The new report has finally eliminated the errors due to disparate methods of reporting in different states. The maternal mortality rate in 2018 is almost exactly the same as it was in 2007.

The US maternal mortality rate did NOT double from 1991 to 2015 as activists repeatedly claimed. Nearly all of the purported increase was due to better reporting, not increased deaths.

From the actual report:

Without the adoption of the checkbox item, maternal mortality rates in both 2015 and 2016 would have been reported as 8.7 deaths per 100,000 live births compared with 8.9 in 2002. With the checkbox, the maternal mortality rate would be reported as 20.9 and 21.8 deaths per 100,000 live births in 2015 and 2016.

I feel justified in saying ‘I told you so.’

Nearly 10 years ago I made many of these points in an article for Salon Magazine, Is there really a “maternal mortality crisis?”.

…[I]t is not clear that maternal mortality is even rising, let alone rising because of decreased access to care or increases in the C-section rate. Review of the data suggests that changes in the way that maternal mortality is assessed may be leading to a spurious “increase” in maternal mortality. Moreover, a detailed analysis of the causes of maternal mortality casts serious doubt on either access or interventions as the reason for any rise.

Over the years I’ve continued to question the conventional wisdom:

The rise in US maternal mortality: the cause will surprise you
Is US maternal mortality rising? Maybe not.
Latest data on US maternal mortality confirms it is a problem of race and healthcare disparities
Experts acknowledge MORE interventions are needed to reduce maternal mortality
Surprise! CDC confirms US maternal mortality rate is high because pregnancy is inherently dangerous.

In 2017, in the wake of a blockbuster report from ProPublica and NPR that advanced the conventional wisdom, I noted:

The take home message about maternal mortality in the US is a lot more nuanced than the ProPublica/NPR piece implied. It’s not a problem of privileged white women who are victims of malpractice. It is a problem with profound racial disparities and changing causes of death. And it’s also a story about what happens when people forget that pregnancy is inherently dangerous and demonize technology instead of using it to save lives.

The problem of maternal mortality persists because we refuse to recognize the nature of the problem and refuse to take the steps necessary to reduce it:

We must stop demonizing C-sections and interventions; they are lifesaving and it is the LACK of interventions that kills pregnant and postpartum women.

We must acknowledge the critical role of race/ethnicity including the fact that international comparisons of maternal mortality are invalid if they don’t correct for race/ethnicity.

We must stop pretending that more midwives and doulas (promoted because they are less expensive) can reduce maternal mortality. The problem is lack of perinatologists and obstetric intensive care units and midwives and doulas cannot fix that.

We must stop pretending that pregnancy is inherently safe when it is inherently dangerous and becomes more dangerous still when women are older or have pre-existing chronic conditions. We should never “trust” birth but should drill endlessly on quick response to hemorrhage, pre-eclampsia and other deadly complications.

In my view, the most important fact about US maternal mortality is this:

…[A]lthough Washington, DC, has the highest maternal mortality ratio in the nation, non-Hispanic white patients in this district have the lowest mortality ratio in the United States…

We are capable of providing excellent, life saving care for those who can afford it. If we want to reduce maternal mortality, we must ensure that all pregnant women — regardless of ability to pay — have access to the highest quality obstetric care.

Another day, another scandal in UK midwifery care. This time it’s not dead babies and dead mothers, all though there are far too many of those. This time it’s the sadistic behavior of midwives.

According to The Telegraph:

Women in labour are being denied epidurals by NHS hospitals, amid concern that a “cult of natural childbirth” is leaving rising numbers in agony.

Mothers said they were told “It’s not called labour for nothing, it’s meant to be hard work” as doctors refused their pleas.

The problem is so widespread that the rate of epidural use is dropping overall:

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Midwifery violence: bullying, pain shaming and denial of epidurals and maternal request C-sections.[/perfectpullquote]

Official guidelines … state that women must be able to access pain relief when they request it, including epidurals.

However, this newspaper has identified six NHS trusts where women pleading for pain relief were refused it.

It comes as official figures show the number of women given pain relief during child birth has fallen. The statistics from NHS Digital show the percentage of women in labour given pain medication such as epidurals has fallen from 67 per cent in 2008-09 to 61 per cent in 2018-19.

Rhiannon Evans of Grazia refers to this practice as pain-shaming:

…[U]nlike the arenas of mental health, other pain, or addiction, where it feels like things are starting to change and messages of kindness are starting to filter through to our collective consciousness, birth is a bizarre no-mans-land of medicine and shame.

It’s a place where the old and new collide, but women are still left worse off. It’s a strange area where the old world says, ‘Come on, this is how we’ve done it for centuries, stiff upper lips, please, women!’ and the new world says, ‘No, it’s your body, your choice, you can do this, women are amazing, but did you know breathing is the greatest anaesthetic ever and breast milk is the cure for everything you could ever imagine?!’ The place where those two worlds intersect is the place where women deal with birth and pregnancy every day. And for many of us, it’s a grim place to be. It’s where the so-called ‘cult of natural childbirth’ lives.

Maybe there would be more attention devoted to midwives’ unethical behavior if we gave it a name. I suggest “Midwifery Violence.”

What’s the definition of midwifery violence?

It is an umbrella term that includes coercion, bullying, pain shaming and denial of epidurals and maternal request C-sections.

Forcing women to labor in pain when effective pain relief is available is sadistic.

In Eve’s punishment rebooted: The ideology of natural birth, philosopher C.K. Egbert explains:

There’s something pornographic about the way we depict childbirth. A woman’s agony becomes either the brunt of a joke, or else it is discussed as an awesome spiritual experience… [W]e talk about the pain of childbirth — with few exceptions, the most excruciating, exhausting, and dangerous ordeal within human experience — as valuable in and of itself. Hurting women is sexy.

Midwives justify their sadism as “better” for babies and mothers. Egbert makes it clear that this justification is nonsense:

… We probably wouldn’t give much credit to an argument that we should strap patients to the operating table and refuse them anesthetic during surgery, even though general anesthetic is usually the most dangerous part of surgery. Rather than eliminating palliative care, we seek safer and more effective means of performing surgeries and administering anesthetic.

Natural birth advocates are not concerned with women’s welfare, because they are not advocating for safer and more effective forms of pain management; they argue they should be eliminated, because women’s suffering is itself a good…

None of this is surprising when you consider that the philosophy of natural childbirth was created by old, white men (Grantly Dick-Read, Lamaze, Bradley) and perpetuated by old, white men (Odent, Marsden Wagner) who tried to convince women that the pain of childbirth was in their heads, not their bodies. And the philosophy of natural childbirth has been perpetuated by white women (midwives, doulas and childbirth educators) who enjoy wielding power over other women and glory in humiliating them for failing to mirror their own choices back to them.

The midwives and doulas who chivvy women into refusing pain relief, who “delay” calling the anesthesiologist when a woman requests an epidural, who promote inadequate forms of pain relief (waterbirth) and praise women as warrior mamas (i.e. “good girls”) for enduring labor without pain relief are sadists. They believe that women’s pain and suffering aren’t worthy of their compassion and concern. They believe that women are improved by agonizing pain, and diminished by relief.

And that is midwifery violence.