One of the biggest ironies of contemporary breastfeeding promotion is how UNnatural it it.

Sure, breastmilk is promoted as best because its natural, but the elaborate demands and restrictions that characterize the Baby Friendly Hospital Initiative (BFHI) are based not on what happens in nature, but on the contemporary philosophy of neoliberalism. Indeed the entire profession of lactation consultant — an expert paid for assistance — is the epitome of capitalism, not nature.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Isolating a new mother in a room by herself with no one else to care for her or her newborn is an unnatural, capitalist concept.[/perfectpullquote]

According to We Need to Talk about Family: Essays on Neoliberalism, the Family and Popular Culture:

Neoliberalism is usually defined as the expansion of economic thinking in all spheres of human activity, including the family …

The individualistic conception of selfhood central to neoliberalism accepts that an individual is both an ideal locus of sovereignty and a site of governmental intervention…

We see its impact in the BFHI that is predicated on individual maternal action and disregards the impact of the family and “the village.” As a result, contemporary breastfeeding promotion is UNnatural, harking back to a past that never existed.

For example, consider the BFHI policy of closing well baby nurseries to force women to room-in with their infants 24/7. There are NO human cultures (no historical cultures, no indigenous cultures, no cultures in developing countries) that leave women alone to care for their infants by themselves from the moment of birth.

According to Traditional postpartum practices and rituals: a qualitative systematic review:

Organized support, usually in the form of family members caring for the new mother and her infant for a specified period of time, is almost universally provided in the early postpartum period by the mother, mother-in-law, other female relatives or husband…

Organized support typically corresponds to a prescribed period of rest, during which the mother is prohibited from performing her usual household chores. In most cultures, the rest period spans between 21 days and 5 weeks, and is considered a period of vulnerability for future illness.

Isolating a new mother in a room by herself with no one else to care for her or her newborn is a modern, unnatural concept. It has nothing to do with nature and everything to do with neoliberalism and capitalism.

Consider the BFHI policy of banning formula supplements. The practice of prelacteal feeding spans time and culture. Odds are high that it reflects the fact that up to 15% of new mothers have insufficient or delayed production of breastmilk. Without supplements, those babies would have died of dehydration.

We’ve ignored these insights about supplementation, ascribing them to ignorance, in favor of our preferred belief that women in indigenous cultures breastfeed early and exclusively. Once again we’ve missed the critical difference between our indigenous foremothers and ourselves. Early supplementation of breastfeeding itself is not harmful; it looks harmful when the only available prelacteal feeds are contaminated with bacteria.

How about pacifiers? They, too, are banned by the BFHI despite the fact that they reduce the incidence of Sudden Infant Death Syndrome (SIDS). Pacifiers have been used for at least the past 12,000 years and probably far longer.

There is evidence that [pacifier] precursors have been used since the Neolithic Period to calm down children. Small balls made of fabric containing food were portrayed in paintings. Other balls made of non-perishable material persisted throughout time…

We’ve ignored the historical evidence of widespread pacifier use because lactation professionals prefer to pretend that women in indigenous cultures used their breasts as pacifiers. That comports with neoliberal fantasies about the mother as an individual actor shorn from her family, her community and the technologies of her time.

What about lactation consultants? There is no such thing as experts for hire in nature. That is an invention of capitalism. Women learned to breastfeed from family members who were invested in the wellbeing of the baby nearly as much as the mother herself. They did not pay money to self-proclaimed experts more concerned with the process of breastfeeding than the outcome of healthy babies.

In truth, supporting breastfeeding does not require banning technology; it requires providing care.

If lactivists really want to increase breastfeeding rates they’d stop trying to recapitulate the absence of technology and concentrate on recapitulating the philosophy of care: it takes a village offering a tremendous amount of help and support — including supplements and pacifiers — to breastfeed a child.

Instead of promoting the Baby Friendly Hospital Initiative, they’d be banning it.

My father died 30 years ago today.

In the picture above, he’s 60 years old, holding my second son less than an hour after his birth. That baby is now a lawyer and married. My father missed it all. He was dead less than 5 months after this picture was taken, although we had no idea at the time that the cancer that would kill him was growing wildly in his chest and had been for months.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Any illusions that I had about the practice of medicine died with my father.[/perfectpullquote]

Any illusions that I had about the practice of medicine died with him.

Many people confuse my condemnation of the pseudoscience of natural childbirth, lactivism and attachment parenting with blind support of the medical profession. Nothing could be further from the truth. I’ve seen the glaring deficiencies of medical practice up close. My father died at the hospital where I had trained, where I was on the staff, where I had convinced him to switch his medical care. He died after a major medical mistake and, but for my aggressive intervention, would have died in agony while my colleagues looked on as if there was nothing they could do to ease his suffering.

I know what bad medical care looks like, and I know how common it is.

My father had a chest X-ray on November 1, 3 months after the photo was taken, and the day after he first coughed up blood. He had a fist size cancer in the middle of his chest. I got the message as I was finishing up in the operating room and hurried to meet him at the office of the chest surgeon. I didn’t have to go very far; I simply took the elevator.

During the appointment, I listened as the surgeon explained the various grim possibilities: lung cancer, lymphoma, etc. They scheduled a biopsy procedure for two days later and the surgeon asked if my father had any questions. He had only one: How could he have a fist sized tumor in his chest if only a few months before (March) he had been in this same hospital to have bladder stones removed, and his pre-op chest X-ray had been normal? The surgeon was sympathetic; sometimes tumors could grow so fast that it they could be too small to detect even a few months previously.

The biopsy revealed adenocarcinoma with an unknown primary. In other word, the cancer was so aggressive that it had lost all the features of the organ where it originated; it might have been lung cancer, but it easily could have been a metastasis from prostate cancer, or indeed any other cancer.

At some point during those days, I thought to look at the original chest X-ray, the one that had been done routinely in March. I wanted to see if, knowing what we knew now, the cancer could be detected in its earliest stages. I went down to the radiology department and requested the film. I was an attending physician at the hospital and had worked there for years. They handed over the film without question.

It is difficult to capture the sense of shock and horror that I experienced on looking at the X-ray. The cancer had been diagnosed on the pre-op film. Ironically, the diagnosis had been very skilled. The cancer was small and indistinct on the original x-ray, but the radiologist had found it anyway and prominently noted it in the written report. I immediately called my father’s primary care doctor to ask if he was aware of this. He admitted that he had known since November 1, as had the chest surgeon. The surgeon had simply lied when he had he led my father (and me) to believe that the original chest X-ray was clear.

Why had they failed to tell my father of the cancer on his original X-ray? Every doctor had thought that the job of telling the patient belonged to someone else. The radiologist thought that the urologist would tell my father, since the urologist had ordered the x-ray. The urologist thought that the radiologist would alert my father if there were anything abnormal on the x-ray. The anesthesiologist was aware that the chest x-ray showed a small cancer, but assumed that either the urologist or the radiologist had told my father. The radiologist actually sent the urologist the x-ray report, which mentioned the cancer, but the as the urologist admitted at trial years later, he had never looked at it.

Why did the doctors lie about it? When I confronted the primary care doctor he claimed that they did it to protect my father. They didn’t want to “lower his morale.” Obviously it was because no one wanted to admit what had happened, and because they wanted to protect each other. I can’t imagine how they thought they would keep it a secret. I worked at the same hospital. I had complete access to all the records, including the X-ray, yet somehow they convinced themselves I would never look.

Despite multiple types of aggressive chemotherapy, my father died 8 weeks to the day after the diagnosis. I wish I could tell you that his last day was a revelatory experience, that I had never realized how poorly dying patients were treated. Unfortunately, I knew better, and therefore was prepared to fight on his behalf.

Oh Christmas evening my mother called me at home to tell me that my father was in agony and no one would help him. I nursed my infant son to sleep and headed for the hospital, my hospital. When I saw my father, I was appalled. He was sitting bolt upright in bed, gasping for air, and clutching his chest.

I paged the intern myself and demanded his presence. The intern, to his credit, was abashed. He acknowledged that my father was clearly in terrible distress, and we agreed that morphine would ease his agony, but the intern refused to order the morphine because it “might hasten” his death.

My father was dying. Every treatment had failed and there was nothing left to try. There was no hope of recovery. And we were going to withhold pain medication … why? To prolong his death?

As you might imagine, I did not take “no” for an answer.

It was well after midnight at this point when the intern woke up his resident. I could hear that the resident was unwilling to order the pain medication, and I grabbed the phone. The resident insisted that he didn’t have the authority, only the oncology fellow could decide.

So I called the oncology fellow myself and woke him up. He couldn’t possibly order pain medication in this setting, because it might slow my father’s breathing and thereby hasten his death. Only the attending physician on call had the authority to issue that order.

Then I called the attending at home and woke him up. He listened and replied, “Look, Amy, I know you’re upset, but it’s the middle of the night. Why don’t we wait until morning when your father’s own doctor will be back and he can make the decision?”

By this point, I may, possibly, have raised my voice a bit, and a crowd of nurses and support personnel had gathered to watch from a discreet distance. I demanded that he appear in person to tell me to my face that he would not order the pain medication.

He relented and I handed the phone to the nurse so she could record the order. I started to relax.

The nurse hung up the phone and I looked at her expectantly.

“I can’t give that morphine,” she said. “I’m not comfortable with giving medication to a patient so near death.”

“You’re not comfortable?” I may, possibly, have yelled. “Not comfortable? Do I look like I care about your comfort?”

I threatened to break into the narcotics cabinet myself and get it, and then report her to the hospital administration for failing to follow an order.

She, too, relented and hung a morphine drip. Within 5 minutes my father began to ease back against the pillows. After 10 minutes, he looked at me and smiled. “I feel great!” he said. “I haven’t felt this good in months. This is terrific.”

He died less than 24 hours later. Throughout the day, he kept telling everyone how wonderful he felt. The rest of my family kept thanking me for demanding what I should not have had to demand: adequate pain relief for a dying man.

And so my beloved father died in the hospital — my hospital — where they had made a dreadful mistake and where they nearly got away with denying him the pain relief that was the only thing they had left to give.

It’s been 30 years and I miss him every day. Believe me, I have no illusions about the state of contemporary medicine.

There is a gift that we could give to mothers every day, and the holiday season would be a great time to start.

What is that gift? Replace words of shaming with words of support.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Let me watch the baby while you take some time for yourself.[/perfectpullquote]

I’ve thought a lot about the concept of shame, especially in relation to the package of mothering choices known as natural parenting. It seems to me that natural parenting has not done much for children, but it has done a lot of harm to women by making them feel ashamed. Mothers have always felt guilty of course, but shame is a relatively new emotion in relation to mothering.

According to the article For Shame: Feminism, Breastfeeding Advocacy, and Maternal Guilt published in the feminist philosophy journal Hypatia. Quoting a variety of mothers who feel like “failures” because they could not breastfeed successfully, the authors explain:

…[T]hey judge themselves as deficient: bad mothers, failures. Such negative global self-assessments suggest what scholars have identified, in contrast to guilt, as shame, which “involves the distressed apprehension of oneself as a lesser creature” or “a painful, sudden awareness of the self as less good than hoped for and expected…”

We can give mothers an incredible gift for the holidays by not shaming them in the first place. Here are a few examples:

1. Epidurals

Support: I’m so glad you got relief from the pain.

Shame: You wouldn’t take drugs the entire nine months of pregnancy; why did you take them in labor?

2. C-section

Support: I’m so glad that your baby is okay.

Shame: Your C-section was unnecessary. If you had been more educated about birth, you would have known that.

3. Breastfeeding

Support: Breastfeeding is difficult. You shouldn’t blame yourself. The important thing is that your baby is thriving.

Shame: There is no such thing as “not enough” milk. And if you were in pain when you were breastfeeding, you were doing it wrong.

4. The family bed

Support: The best sleeping arrangements differ for different families and even for different children within the same family.

Shame: What do you mean you need private time with your husband? Your baby is only young once; you’ll be married to your husband for decades.

5. Baby wearing.

Support: It’s great if a sling works for you, but the baby really doesn’t care as long as she is with you.

Shame: Your baby won’t feel loved if you don’t “wear” him. And without skin to skin contact, babies suffer from stunted emotional development.

6. The all consuming nature and isolation of caring for small children

There are lots of different way to shame women about this issue: Isn’t being with your baby more important than making money? I love my baby enough to do without material things.

Or, what do you mean you need time for yourself? There is nothing that you could be doing that is more satisfying than meeting your baby’s needs.

Or, I can’t believe you leave your baby with a sitter just so you can go to yoga class for an hour.

There are a lot of different ways to support for mothers who feel isolated and temporarily overwhelmed with parenting duties, but my personal favorite is this:

Bring the baby over to my house and I’ll watch him while you take a little time for yourself.

Happy Holidays!

Why do so many aspects of natural mothering — ostensibly designed to protect babies — end up harming them?

Natural childbirth, marketed as “safer” than modern obstetrics, was embraced wholeheartedly by midwives in the UK. The result has been the preventable deaths of dozens, possibly hundreds, of mothers and babies and massive maternity scandals like Morecambe Baby and Shrewsbury/Telford. According to the Independent, the government has thus far spent $65 million compensating and caring for the victims in JUST Shrewbury/Telford. And this is only the beginning.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Natural mothering promotes inequality, male dominance and women immured in the home as “natural.”[/perfectpullquote]

Breastfeeding is promoted as “best” for babies, but none of the purported benefits predicted for term babies in industrialized countries — reduced infant mortality, reduced severe morbidity, reduced healthcare costs — has come to pass. Worse, exclusive breastfeeding has become the LEADING cause of newborn re-hospitalization (tens of thousands of hospitalizations each year at a cost of hundred of millions of dollars). Shockingly, there has been an increase in babies dying by being smothered in or falling from their mothers’ hospital beds as a result of the closing of well baby nurseries.

Attachment parenting, which fetishizes constant, close contract between a baby’s body and that of his mother is promoted as improving child health, confidence, happiness and achievement. To my knowledge, there is no evidence that even a single parameter of child mental health has improved in the 25 years since its inception, and quite a few child mental health parameters have declined.

Why has a philosophy touted as benefiting babies ended up hurting so many of them?

Because natural mothering was never about babies; it’s always been about “naturalizing” the coercion of women. Given the rising rate of postpartum anxiety and depression, it has been quite successful in its real aims.

Psychologist Susan Franzblau has written about this issue. Although Franzblau refers to attachment theory in her writing, it seems to me that she is criticizing natural/attachment mothering.

First, attachment theory steers women into accepting motherhood as the dominant condition of their lives, by characterizing and then romanticizing women as mother. Second, attachment theory promotes women’s labor within the confines of maternity by narrowing, reducing, and mandating women’s primary role as that of heterosexual mother. Third, attachment theory acts as the overarching paradigm with which to scrutinize women to see if their behavior meets the definition of “good mother.” Finally, if a woman resists the work of motherhood, either in thought or deed, attachment theory pathologizes her resistance.

Natural mothering elides its coercive, misogynist origins by insisting that it has the imprimatur of science. Franzblau describes it as “ideology configured as science.” And it’s not particularly good science because it takes animals, particularly higher order mammals and primates, as a starting point for determining normative behavior for women. In doing so it assumes inequality, male dominance and female nurturance of infants. In other words, the only thing natural about natural mothering is the gender stereotyping.

The ideology of natural mothering conveniently intersects with societal and political efforts to marginalize women. This is not the first time that mothering has been romanticized. It also occurred in the Victorian era and the immediate aftermath of World War II. In both cases, structural issues (the Industrial Revolution, the return of men from the military) made it attractive to pressure women back into the home, reserving employment for men. This was justified by ignoring women’s needs in favor of restricting them to their biological functions.

It the 21st Century, these so called experts are midwives, doulas, lactation consultants and attachment parenting advocates. Women’s needs are ignored and women who don’t want to give birth without pain medication, don’t want to breastfeed, and dare to have careers outside the home are pathologized as weak, lazy and selfish.

The bottom line is that natural mothering has never been about what’s best for babies; it’s always been about manipulating women into pre-approved choices by claiming sexist ideology is science.

It’s very challenging to explain science to those with low scientific literacy.

Consider my oft repeated claim that the predicted benefits of breastfeeding (based on mathematical models) have never been shown in real populations. Lactation professionals do not deny this. Indeed, in a memorable exchange I had with Dr. Melissa Bartick, she actually confirmed it.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]The same way we know that routine episiotomy doesn’t have the benefits claimed for it.[/perfectpullquote]

In the comment section of a piece on the Academy of Breastfeeding Medicine blog, I asked Dr. Bartick directly:

Where is the evidence that term babies lives has been saved? Where is the evidence that the diseases you insist are decreased by breastfeeding are actually decreasing as a result of breastfeeding? Where are the billions of healthcare dollars you claimed would be saved as the breastfeeding rates rose?

Her response:

… To my knowledge, no one has actually dug it up yet.

Even Dr. Bartick acknowledges that the evidence simply doesn’t exist.

But low science literacy lactivists like Lisa Bridger of the FABIE Facebook group (Fed Ain’t Best, It’s Expected) are struggling mightily to understand.

Layne Sullivan, a member of Bridger’s group, asks:

How could it be studied without mathematically modeling?

And:

[H]ow could you possibly remove every confounder that predicts health? There are hundreds. It is not possible.

Bridger, demonstrating a different aspect of low scientific literacy, writes:

Sure more women in the US are initiating breastfeeding but less than 25% are actually meeting the world health organisation recommendations for exclusive breastfeeding for 6 months. So how can she demand results, when the foundation hasn’t been achieved??? Not a single country in the world is achieving the WHO recommendations, yet she sees her perceived lack of data as a slam potato dunk

How can I explain science to those whose understanding of science (and math and statistics) is so low that they make such nonsensical claims? I’m hoping I can explain it by analogizing to something they already believe:

How do we know that breastfeeding doesn’t have the benefits claimed for it? The same way we know that routine episiotomy doesn’t have the benefits claimed for it.

Serious vaginal tears had posed significant health hazards for women since time out of mind. They could lead to permanent urinary incontinence, permanent dribbling of stool from the vagina and permanent sexual dysfunction.

Tears occur when the diameter of the baby’s head exceeds the capacity of the vaginal opening to stretch to accommodate it. Doctors reasoned (wrongly as it turned out) that by cutting an episiotomy to accommodate the baby’s head they could avoid jagged tears and injury to the nearby bladder and rectum.

Why don’t doctors cut routine episiotomies any more? Canadian obstetrician, Michael Klein, decided to find out if the predicted benefits actually occurred in real populations. Despite the fact that everyone “knew” that episiotomies prevented severe vaginal tears, Dr. Klein showed that women who underwent episiotomies were MORE likely to experience a severe tear.

Dr. Klein did not “model” the impact of episiotomies, he looked at what actually happened when women were cut. He compared the predicted benefits of episiotomy to the actual benefits of episiotomy and found out that the predicted benefits did not exist.

Contrary to Bridger’s misunderstanding of research, Dr. Klein did not need to investigate what would happen if 100% of women had episiotomies. He didn’t have to reach any specific threshhold. He merely had to compare what the model predicted for ANY given episiotomy rate and the actual outcome at that episiotomy rate.

Layne Sullivan also misunderstands what it required for proof. Real world evidence is far more important than mathematical models.

Population based data shows that episiotomy not only doesn’t reduce the incidence of severe tears; it increases it. Real world breastfeeding data — as Dr. Bartick acknowledges — fails to show any reduction in term infant mortality, severe morbidity or healthcare costs. Dr. Bartick’s models are wrong.

How about confounding variables? They can never be eliminated entirely, but science does not require that they be entirely eliminated. Advanced statistical methods can correct for the most important confounding variables. If a benefit no longer exists after correcting for confounding variables, it wasn’t a real benefit in the first place.

The bottom line: we know that breastfeeding doesn’t have the benefits predicted for it the same way we know episiotomy doesn’t have the benefits predicted for it — by looking at population data and correcting for confounding variables.

The conventional wisdom among many laypeople is that natural is best.

Advertisers market it. Organic food purveyors rely on it. And it is obviously at the heart of natural childbirth advocacy and breastfeeding promotion. Women are supposedly designed to give birth vaginally and breastfeed. As a result, those who give birth vaginally and breastfeed are supposedly bestowing a gift of better health on their babies.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Survival of the fittest means a lot of babies naturally die.[/perfectpullquote]

But that, like nearly all of natural childbirth and breastfeeding advocacy, is nonsense that reflects a deep and abiding misunderstanding of evolution. In birth and breastfeeding the difference between natural and medical is NOT the difference between best and second best. It’s the difference between survival of the fittest and survival of the most.

Simply put, survival of the fittest means that by definition not everyone survives. Lots of people die. In the case of childbirth it means high levels of neonatal and maternal mortality. In the case of breastfeeding, it means high levels of insufficient breastmilk for mothers and dehydration, jaundice and failure to thrive by babies. And in contrast to the nattering of natural childbirth advocates and lactivists, high rates of offspring death are natural for the rest of the animal kingdom, too.

Modern medicine, in contrast, rests on the moral principle of survival of the most.

We don’t throw up our hands when a grown man breaks his leg; we don’t start planning the funeral for when he dies of starvation because he can’t hunt or is eaten by a predator because he can’t run away. Even in pre-history his group or tribe would have splinted the leg to promote proper healing and fed and protected him until he could once again hunt his food and protect himself. Moreover, we don’t pretend that a broken leg is a variation of normal that should be ignored or that, once healed, the man is somehow “lesser” than his peers.

Similarly, we shouldn’t throw up our hands when a baby is one of the 4% in the breech presentation and declare that such a baby is less fit and therefore not worthy of our concern. Even in prehistory, “wise women” trained each new generation to master special techniques to save babies from deadly breech complications. They didn’t pretend that breech was a variation of normal that should be ignored or that a baby delivered from the breech position was somehow “lesser” than her peers. Today was can improve further on the survival of breech babies by offering C-sections. We are always striving to save more babies.

Eyes are designed to see, but that doesn’t change the fact that 30% of the population will develop nearsightedness. Today, when a child or adult becomes nearsighted, we don’t throw up our hands and lament the fact that they aren’t the fittest and are henceforth less likely to survive. We provide vision correction in the form of glasses or contacts; we even the odds of survival; and we don’t deride the products and achievements of those wearing glasses as inferior to the products and achievements of those with 20/20 vision. We act to ensure excellent vision for the most, not acquiesce to it being the province of only the fittest.

Breasts are designed to breastfeed but that doesn’t change the fact that up to 15% of first time mothers will not produce sufficient breastmilk to fully nourish a baby, especially in the days immediately following birth. Contemporary lactivists have chosen to thrown up their hands in the face of insufficient breastmilk and declare that it doesn’t exist (“cluster feeding is a variation of normal”) and to fetishize exclusivity. They’d literally prefer to stick an IV in a baby’s head vein, or feed him dextrose gel for no better reason than to pretend that the baby was “exclusively” breastfed. There’s a much easier way to ensure survival of the most babies; supplement with formula.

The dirty little secret about breastfeeding is that formula saves more lives than breastfeeding ever could. Breastfeeding has a high failure rate (up to 15%) while formula has an exceedingly low failure rate. Yet lactivists still cling to their cherished belief that breastfeeding must be better than formula because natural is always best. Yet nature allows for survival of only the fittest while technological formula allows for survival of the most.

Is vaginal birth “best”? Is breastfeeding “best”? How can they be when they only ensure survival of the fittest? The best outcome is survival of the most.

Anti-vaccine sentiment, in addition to being intellectually bankrupt, is remarkably immoral.

Anti-vaxxers have been known to declare:

I’m not going to set MY child on fire to keep YOUR child warm!

Consider what that statement means. The anti-vax parent who utters it does so on the assumption that vaccines work and that herd immunity is real. She recognizes that vaccines protect the most vulnerable among us, but refuses to contribute to that protection. She’s not willing to accept any risk to her children from vaccines in order to protect all children in the community.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Anti-vaxxers are free loaders.[/perfectpullquote]

But the statement isn’t just unethical; it’s completely backward. When an anti-vax parent refuses to vaccinate what she’s really saying is this:

I’m happy to keep MY child warm by setting YOUR child on fire.

She’s happy to accept the benefits of herd immunity for her children (the warmth), while letting the most vulnerable children get sick and die (the fire resulting from refusal to vaccinate). And if figuratively setting vulnerable children on fire isn’t enough to keep her child warm, she’ll get him or her vaccinated.

For example, earlier this year:

Demand for measles vaccines leapt 500 percent last month in Clark County, Washington—a hotbed for anti-vaccine sentiment that has now become the epicenter of a ferocious measles outbreak.

As of February 6, the county which sits just north of the border from Portland, Oregon—has tallied 50 confirmed cases and 11 suspected cases of measles since January 1. The case count is rising swiftly, with figures more than doubling in just the last two weeks. On January 18, the county declared a public health emergency due to the outbreak.

The ugly truth about anti-vaxxers is that they are free-loaders. They expose other people’s infants and immunocompromised children to injury and death. But when their own children face the very same risk of injury and death they were willing to countenance for other mothers’ children, they vaccinate.

It’s an example of the ethical conundrum known as the free rider problem.

The classic example is a conservation water ban. People in a town are told not to water their lawns in order to conserve water for drinking. Most people, understanding the importance of having enough water to drink, comply. However, there are always a few people who secretly violate the ban. They believe that they will be protected from a water shortage because everyone else is conserving, and — immoral as they are — they imagine they are entitled to keep their own lawns green.

Free riders are free loaders and they’re unethical.

How do we know? If everyone ignored the water ban the town would run out of water for people to drink and everyone would be harmed. So no matter how much you might want to water your lawn during a water ban, it is unethical to do so. It doesn’t matter that the harm is not immediate, or that no one can draw a direct line between your violation of ban and the lack of water. People who continue to water the lawn during a water ban are stealing an unfair share of a communal good and put the entire community at risk. You have to be remarkably entitled to imagine that you have a right to do that.

Similarly most people, understanding the importance herd immunity, vaccinate their children. In contrast anti-vaxxers assume that they will be protected from diseases like measles because everyone else is vaccinating, and — unethical as they are — they imagine they are entitled to keep their own children unvaccinated. But anti-vaxxers have been stealing an unfair share of a communal good (the high level of vaccine induced immunity) and, because of their immoral actions, the entire community is now facing a terrible risk.

In contrast to their delusions, no one is asking anti-vaxxers to set their own children on fire to keep other people’s children warm. We’re merely insisting that they stop lighting other people’s children on fire to keep their own children warm.

Intensive mothering (often called natural mothering) is the dominant mothering ideology of industrialized countries in the early 21st Century.

Hallstein et al. explore intensive mothering through the lens of celebrity moms in a chapter from the new book The Routledge Companion to Motherhood. They describe it as “the new momism.”

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Intensive mothering replaces women’s traditional subservience to their husbands with subservience to their children.[/perfectpullquote]

The new momism is the form of intensive mothering that emerged in the 1980s and continues to be in full force today, albeit in new and more intensive ways… Douglas and Michaels argued that this “good mothering” ideology rests on three core beliefs and values:

“the insistence that no woman is truly complete or fulfilled unless she has kids, that women remain the best primary caretakers of children, and that to be a remotely decent mother, a woman has to devote her entire physical, psychological, emotional, and intellectual being, 24/7, to her children”.

… In addition to creating impossible ideals of mothering, the new momism also defined women first and foremost in relation to their children and encouraged women to believe that mothering was the most important job for women, regardless of any success a woman might have had prior to motherhood.

Simply put, intensive mothering is a way to constrain women by replacing their traditional subservience to their husbands with subservience to their children.

What is the role of celebrity mothers?

… Douglas and Michaels argued that celebrity mom profiles primarily worked to encourage guilt and failure in mothers because the profiles always showed celebrity moms juggling it all – work, family, and mothering – with ease and without difficulty… The hallmark of these profiles was to show celebrity moms glowing, happy, content, and with their children, often one-to-two years postpartum, while the moms extolled the virtues of motherhood.

The entire chapter is fascinating but one issue in particular caught my eye because it confirms something I have been observing for at least a decade: intensive mothering is becoming more intensive!

While there is no doubt that the new momism has always been a demanding approach to mothering, by the late-2000s, scholars and writers … began to argue that intensive mothering was intensifying and contemporary mothers were doing even more motheringrather than less, even though more and more American women were working…

This intensification does not mean, however, that the three core principles of the new momism have changed. Rather, the core principles have only become more demanding and exacting for mothers and require mothers to devote even more time and energy to their mothering and children in order to be “good” mothers.

What has changed, then, is that contemporary motherhood requires mothers to have and utilize yet more energy to meet the even-more demanding requirements of “good” mothering today.

You can see this in the realms of natural childbirth, breastfeeding and attachment parenting.

The father of natural childbirth, Grantly Dick-Read, thought that natural childbirth meant “awake” childbirth unlike the majority of women who had general anesthesia for birth. Over the years, particularly after the advent of the epidural, which allowed women to be both awake and pain free, the goal posts were repeatedly moved. Natural childbirth came to mean avoiding any pain medication, any interventions of any kind, using a midwife and doula, and preferably giving birth at home far from medical aid.

Breastfeeding promotion used to mean breastfeeding and nothing more. Now it is hedged around with ever more onerous restrictions including the fetishizing of exclusivity (“just one bottle can be harmful”), the closing of well baby nurseries, and the entirely new phenomenon — found in no other historical or contemporary culture — of expecting women to fully care for their babies from the moment the placenta detaches.

Attachment parenting fetishizes proximity. Mothers are supposed to “wear” their babies and never be parted from them even to sleep at night.

The ultimate irony is that the intensification of intensive mothering has made it dangerous for babies. Homebirth and the arbitrary refusal of obstetric interventions increase the risk of death for babies; exclusive breastfeeding now results in the re-hospitalization of tens of thousands of babies each year; bed-sharing is literally deadly for babies. No matter. Intensive mothering has NEVER been about what’s good for children; it’s always been a way to control women, keeping them out of the workforce and protecting men from the economic competition that they represent.

There’s nothing wrong with intensive mothering if that’s the choice that a woman thinks is best for her children and herself. But there’s something very wrong with constructing intensive mothering as an ideal and pretending it is the sum total of good mothering.

Natural childbirth, breastfeeding and attachment parenting have little to nothing to do with the way that children turn out. I’m not aware of a single physical or mental health parameter that has improved for children because of intensive mothering.

Mothering is far more complex than fetishizing breastfeeding exclusivity or fetishizing maternal proximity. But that doesn’t matter when the real goal is to keep women subservient.

Breastfeeding is a good thing. Lactivism? Not so much.

Breastfeeding is the act of feeding a baby at a mother’s breast. Lactivism, while claiming that feeding a baby at a mother’s breast is critical to the health and wellbeing of the baby, is really about the mother’s ego. Hence the slogan “breast is best” a slogan that lactivists are willing to defend to the death … of underfed babies.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]If breastfeeding isn’t best, then lactivists aren’t best.[/perfectpullquote]

Don’t believe me? Exclusive breastfeeding is now the leading cause of newborn re-hospitalization. Approximately 40,000 babies are readmitted to the hospital each year at a cost of hundreds of millions of dollars. I have yet to find a lactation organization — not La Leche League, not the Baby Friendly Hospital Initiative, not Baby Friendly USA — that dares deny these facts.

Why the willingness to sacrifice the health and well being of babies and mothers to promote breastfeeding? There are two reasons:

1. Breastfeeding is a multi-billion dollar business that represents 100% of the income of breastfeeding professionals. The moralization of breastfeeding has closely paralleled the monetization of breastfeeding.

Is the breastfeeding industry as large as the formula industry with which it competes? No, but formula manufacturers have multiple products while the breastfeeding industry has only one. The income of breastfeeding professionals is arguably far more important to them than the income of formula is to multi-national conglomerates.

You don’t have to be an economist to understand that if women realized just how trivial the benefits of breastfeeding are in industrialized countries, they’d be spending far less money on lactation consultants.

2. The second reason for the willingness to sacrifice the physical health of babies and the mental health of mothers on the altar of breastfeeding promotion is even more powerful. Lactivism is ego driven. Breastfeeding has been weaponized in the mommy wars. If breastfeeding isn’t best, then lactivists aren’t best.

This was the original goal (and some might argue the continuing goal) of La Leche League. It was formed in the late 1950’s by women who were religious traditionalists and sought to keep mothers of young children from working. They reasoned that if women could be convinced that breastfeeding was important, fewer women would go to work.

The founders of LLL did not invoke medical benefits of breastfeeding since no one was aware of any medical benefits of breastfeeding. They simply decreed that women who stayed home with their young children were better mothers than those who did not stay home. As late as the 1970’s LLL’s national leadership argued about whether a working mother — even one who fed her child only breastmilk — could be a good mother.

The medical benefits of breastfeeding were not “discovered” until the advent of lactation consultants. Nearly all of these benefits were asserted in the absence of any scientific evidence. It was almost a decade before the first research studies were produced that seemed to support these “benefits” and another decade before nearly all them were debunked by studies that finally corrected for confounding variables like maternal education and socio-economic status. That second wave of studies demonstrated that most of the benefits ascribed to breastfeeding were benefits of relative wealth. Indeed, recent studies have shown that “intention to breastfeed” provides the SAME benefits as breastfeeding itself.

But over the years, many women imbibed the subliminal message conveyed by “breast is best”: that breastfeeding mothers are better mothers than women who formula feed. And they are not about to give up the ego gratification that veneration of breastfeeding provides. That’s why there has been such a visceral reaction among lactivists to the soaring popularity of the “fed is best” movement. If breast isn’t best for every baby (and it isn’t), then they are not the best among mothers.

Watching them fight back is alternately painful and hilarious. It’s painful since their sense of self-worth is so closely tied to their ability to lactate. As we approach 2020, it is disappointing to realize that so many women still believe that their only value lies in the function of their reproductive organs.

It is hilarious because …. well, I’ll let you judge for yourself. Head over the the FABIE Facebook group. The name is an acronym for “Fed Ain’t Best, It’s Expected.” It is run in large part by Lisa Bridger an Australian lactivist who achieved her 15 minutes of fame by declaring that she breastfed her school age sons.

Every post is about boosting their egos as the “best” mothers and denigrating anyone and anything that interferes with their ego gratification. Most posts are taken directly from the Fed Is Best facebook pages and the Skeptical OB facebook page. (Ironically, they drive a significant proportion of my Facebook traffic.) Anyone who doesn’t agree that they are the best mothers is vilified and labeled a “potato.” The internalized misogyny is on full display with frequent comments about the appearance of those with whom they disagree.

Their viciousness is on full display when they attempt to debunk or simply refuse to believe stories of babies and mothers harmed by aggressive breastfeeding promotion. They are so psychologically needy that they have no compassion left over for babies and women who have suffered as a result of lactivism.

Fortunately, the tide is turning.

Lactation consultants may be clinging desperately to the purported “benefits” of breastfeeding even though they can’t seem to show that they occur anywhere but in mathematical models. And lactivists are still desperately clinging to their cherished belief that the use of their breasts — not their actual parenting — marks them as superior mothers. But a large and fast growing number of mothers and health professionals are realizing that “fed is best.”

Lisa Bridger and the FABIEs will just have to find another source of ego gratification.

I tried Facebook Live for the first time today! I did a 30 minute question and answer session.