The following is a guest post from the doctor who wrote A cardiologist’s experience with a “baby friendly” hospital warning women about the off label use of domperidone (a drug typically used to suppress nausea) to improve milk supply in breastfeeding mothers. This message could save your life:

Domperidone is a non-FDA approved drug which is often touted to breastfeeding mothers as a remedy for low supply. It’s available over the counter in many European countries, and can easily be obtained from internet pharmacies.

As a cardiologist, I’m very concerned about this drug, and the European Drug safety agency agrees. Here’s why:

1. Domperidone prolongs the QT interval. This means that it alters the speed and duration of certain electrical currents in cardiac muscle cells, making them very susceptible to a dangerous arrhythmia called torsades de pointes. If this occurs, the heart stops beating and the patient will die unless she is shocked with a defibrillator within seconds. Survivors often suffer from HIE.

2. QT prolonging drugs are silent killers. The first symptom that anything is amiss is that the patient literally drops dead from a malignant arrhythmia. The only (imperfect) way to screen for it would be to do serial ECG’s before and after starting the drug in a hospital environment with full resuscitation equipment nearby. Obviously this is not going to happen with an off-label drug bought off the internet.

3. When a woman is taking this drug on her own initiative from an internet pharmacy, she probably won’t mention it to her doctor. If she is prescribed another drug with QT prolonging effects on top of the domperidone, eg a quinolone antibiotic for postpartum UTI, or antidepressant for PPD, she is at an extremely high risk for arrhythmias. The list of QT prolonging meds is very long and keeps growing, so ideally a doctor should consult it for every new prescription to a patient taking domperidone.

4. Advising a woman to risk her life with this dangerous drug only to be able to breastfeed, is so fundamentally unethical it makes my blood boil. The only excuse these lactation consultants and midwives have is that they don’t have the knowledge to understand what they are doing. Someone who hasn’t been to medical school really has no business playing with this stuff.

5. If the risk to the mother isn’t enough, there’s a risk to the baby too. Domperidone is transferred in breastmilk (LC’s often deny this!) and infants are exquisitely sensitive to its effect. How many ‘SIDS’ cases out there are in fact sudden cardiac deaths from arrythmias caused by maternal domperidone use?

6. Breastfeeding support organisations bear a shattering responsibility here. Where is the big lettered warning on the La Leche League website? Where is their official position statement forbidding their leaders to endorse this drug? They have blood on their hands.

My bottom line is: it isn’t worth it. If you need domperidone to keep your supply, throw it out and start supplementing. You risk death or permanent disability, not only for yourself but for your baby too. I know firsthand how heartwrenching it is to want to breastfeed your baby, and not be able to. The feelings of guilt, fear and inadequacy combined with postpartum emotional vulnerability are completely overwhelming. It’s enough to make the most levelheaded woman look into these harebrained methods. Please don’t make yourself a victim.

Editor’s note: The recommendation to use domperidone off label to increase breastmilk supply shines a light on the essential hypocrisy of the natural childbirth and homebirth movements. The same people who are shocked about the off label use of Cytotec, and imply that off label means illegal, seem to have no problem with the off label use of domperidone. What’s the difference? Modern obstetrics is “bad” and the off label use Cytotec “proves it.” But breastfeeding is “good” so anything, even the off label use of a drug that might kill the mother, must be “good.”

Years ago, when I was a chief resident, I received a call from the local women’s prison. They wanted to send over an inmate who was 9 months pregnant so she could have an ultrasound. I asked why and was flabbergasted by the reply. The woman had told the prison staff that she believed that she was carrying the child of the devil. Apparently the staff imagined that if I performed an ultrasound I could convince her that the child was not Satan’s baby. It seemed not to have occurred to them that the woman was suffering psychotic delusions and that an ultrasound was not the appropriate treatment for that problem.

I was reminded of that incident when I read about a recent tragedy in New York City.

On Wednesday afternoon, Cynthia Wachenheim did the unthinkable: She strapped her 10-month-old son to her chest and leaped from the eighth floor of her building.

Wachenheim, 44, died. But baby Keston Bacharach survived, his fall cushioned by his mother’s body, with only a few scratches.

New information reveals the motivation — guilt and fear — that led to Wachenheim’s fatal decision to end her own life and try to end her son’s.

According to a law enforcement official who spoke with the New York Times, Wachenheim left a 13-page suicide note explaining the guilt she felt over two previous incidents in which her child had fallen.

Wachenheim wrote of her belief that the “shameful incidents” — one, when Keston had fallen from a play set onto a wooden floor, and another, when he had rolled off a bed — were the fault of a series of seizures and concussions that would cause Keston suffering his whole life.

No, no, no. She was not suffering from guilt and fear. She was almost certainly suffering from postpartum psychosis.

According to the Massachusetts General Hospital Center for Women’s Mental Health:

Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is a rare event that occurs in approximately 1 to 2 per 1000 women after childbirth…

… Women with this disorder exhibit a rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganized behavior. Delusional beliefs are common and often center on the infant. Auditory hallucinations that instruct the mother to harm herself or her infant may also occur. Risk for infanticide, as well as suicide, is significant in this population.

In other words, Cynthia Wachenheim was in the grip of a psychotic delusion that probably arose in connection with the hormonal changes of the postpartum period.

But amazingly, that didn’t stop Elie Mystal at the legal blog Above the Law, from writing this ignorant, unspeakably cruel piece:

I know that society requires and expects me to use restraint or even show sympathy for suicide “victims.” But I just can’t muster the will to conform to social conventions in this case. This woman left behind a 13-page suicide note (of course a lawyer leaves a 13-page suicide note) explaining that she thought her baby had cerebral palsy based on internet research (doctors found nothing wrong with the child). When nobody believed her crazy rantings, her solution was to try to kill her own child — as if even an actual diagnosis of CP was worse than death.

Screw this woman….

Screw this woman? The woman was in the throes of a psychotic delusion. Psychotic: that means it was the product of a mind afflicted with a very serious illness. Pretending she should have just “bucked-up” when people dismissed her delusional fears makes as much sense as pretending that an ultrasound is going to convince a psychotic woman that she isn’t carrying the devil’s baby.

The blogger continues to express his mind blowing stupidity:

Having just been through the process of having a newborn, I’m acutely aware of all the time hospitals, pediatricians, and psychiatrists put in telling new parents how to handle the feelings of anxiety and sometimes depression that affect new parents. According to the reports filtering in about Wachenheim’s suicide note, it seems like she refused to listen to anybody else or seek out readily available help for her mental health issues.

Of course she didn’t listen to anybody else, and whether she did or did not seek out psychiatric help is irrelevant. She was delusional!

Finishing with a flourish of ignorance, the blogger concludes:

I don’t know, Casey Anthony (allegedly) kills her child, and she’s a monster. This woman most certainly tries to do the same thing, but she’s a “victim” because she tried to kill herself at the same time?

Don’t let the fancy law degree and respectable job fool you; she’s a monster.

She was not a monster. She was suffering from psychosis. She should not be held responsible for her actions because they were the product of a mind that couldn’t tell the difference between what was real and what she feared.

Defending Wachenheim, Slate columnist Jessica Grose goes overboard in the other direction.

The specific anxieties that Wachenheim mentioned in her suicide note are extreme and obviously the thoughts of a disturbed mind. Still, it’s alarming how much they reflect the current thinking about how much mothers are responsible for the ultimate sound health of their newborns. What they eat, what they don’t eat, what mood they are in, how long they wait to get pregnant, even what music they listen to—mothers are constantly reminded that every move they make can leave lasting damage on a baby and make them more prone to get even serious diseases like autism and other developmental disorders… Of course Wachenheim’s psychotic mind could have grabbed onto some other anxiety if fears of autism weren’t so outsized in the United States. But her case should give us a slap-in-the-face reminder to lay off a little—new mothers can be vulnerable enough without the extra anxiety.

Grose’s heart is in the right place, but even she fails to appreciate that Wachenheim’s delusional thinking was a direct result of her illness, not societal pressures. Yes, those pressures exist, and I have spent a great deal of time railing against them on this blog, but that’s not even a small part of Wachenheim’s problem. It’s the equivalent of blaming the movie Rosemary’s Baby for my patient’s delusion about carrying Satan’s child. The pressures of contemporary parenting ideologies are responsible for tremendous amounts of anxiety, guilt and unhappiness, but they don’t cause psychosis or contribute to it.

Postpartum psychosis is an illness, just like type 1 diabetes is an illness. And like type 1 diabetes, it is almost certainly related to hormonal imbalances. It is not the fault of the patient who is afflicted by it and it is not the fault of society. It’s just a disease, a disease that can strike previously healthy women with little or no warning and like any serious disease, it deserves our compassion, understanding and intense efforts to understand and treat it. To blame a dead woman for her own psychotic delusions is a sign that we have a long, long, long way to go in educating people about postpartum psychiatric illness. Elie Mystal and Above the Law should publicly apologize to Cynthia Wachenheim’s family for adding to their unimaginable pain by expressing their painfully retrograde, woefully ignorant views.

Homebirth midwives, doulas and childbirth educators have a problem. They are obsessed with a paleo-fantasy of birth that has nothing to do with the reality of birth. And because they base their efforts on the paleo-fantasy, instead of reality, almost all their empirical claims are flat out false.

What’s a “paleo-fantasy”? According to Professor Marlene Zuk, author of the new book Paleofantasy: What Evolution Really Tells Us About Sex, Diet and How We Live:

It is striking how fixated on the alleged behavior of our hunting-and-foraging forbearers some educated inhabitants of the developed world have become. Among the most obsessed are those who insist, as Zuk summarizes, that “our bodies and minds evolved under a particular set of circumstances, and in changing those circumstances without allowing our bodies time to evolve in response, we have wreaked the havoc that is modern life.” Not only would we be happier and healthier if we lived like “cavemen,” this philosophy dictates, but “we are good at things we had to do back in the Pleistocene … and bad at things we didn’t.”

Starting with Grantly Dick-Read, and extending to contemporary homebirth midwives, doulas and childbirth educators, natural childbirth advocates have adopted the belief that birth evolved under a particular set of circumstances and that changing the way we care for childbearing women without those women’s bodies having time to evolve in response, has wreaked havoc on women and babies.

Zuk is not writing about childbirth, but her thesis applies just as well to childbirth as to contemporary beliefs about diet.

Zuk detects an unspoken, barely formed assumption that humanity essentially stopped evolving in the Stone Age and that our bodies are “stuck” in a state that was perfectly adapted to survive in the paleolithic environment. Sometimes you hear that the intervention of “culture” has halted the process of natural selection. This, “Paleofantasy” points out, flies in the face of facts. Living things are always and continuously in the process of adapting to the changing conditions of their environment, and the emergence of lactase persistence indicates that culture (in this case, the practice of keeping livestock for meat and hides) simply becomes another one of those conditions.

In other words, hunter gathers were never “perfectly evolved,” they represented the best adaptations to conditions as they existed at that time. Conditions have changed dramatically over the past 10,000 years, which means that what was good for them, has no relevance for what is good for us. Moreover, and this is the critical point that is completely ignored by the paleofantasists, we have continued to evolve in keeping with our changing environment. For example, consider:

… “lactase persistence” (the ability in adults to digest the sugar in cow’s milk), a trait possessed by about 35 percent of the world’s population — and growing, since the gene determining it is dominant. Geneticists estimate that this ability emerged anywhere from 2200 to 20,000 years ago, but since the habit of drinking cow’s milk presumably arose after cattle were domesticated around 7000 years ago, the more recent dates are the most likely. In a similar, if nondietary, example, “Blue eyes were virtually unknown as little as 6000 to 10,000 years ago,” while now they are quite common. A lot can change in 10,000 years.

The idea that contemporary women should be attempting to emulate the births of their foremothers, ignores evolutionary science and is fairly idiotic to boot.

There was never a time that women were “perfectly designed” to give birth, because there has never been a time that any species has been perfectly evolved for anything. Every species, at every time, represents a host of compromises that, together, make that species competitive within a specific environmental niche. As soon as the environment changes, and it always changes, sometimes very rapidly, the species, while exactly the same as it was before, is suddenly no longer as competitive. That’s why most of the species of animals and plants that have ever existed are already extinct. They couldn’t change fast enough and died out as a result.

Human beings have the added advantage of technology. We can change our environment and we can change ourselves in ways that evolution would never allow. Ten thousand years ago if a woman began labor with her baby in a persistent transverse position, both she and her baby were guaranteed to die, a slow, agonizing death. Today, the mother would have a C-section and both mother and baby would survive. Ten thousand years ago, that mother and baby would have been evolutionary losers. Today they are evolutionary winners, because the currency of evolution is offspring. If your offspring survive, you win. If they die, you lose. It is just that simple.

There used to be an evolutionary advantage to being able to give birth vaginally. Now, with the advent of the C-section, there is absolutely no advantage, evolutionarily or otherwise, to a vaginal birth. Venerating vaginal birth and attempting to emulate it as it supposedly occurred in nature makes as much sense as polar bears venerating their original brown fur and attempting to emulate it. The environment has changed and the evolutionary winners and losers have changed as a result.

Scientists are sometimes caught out as paleofantasists as well. Consider the latest “research” about C-sections and the infant gut microbiome. There are scientists insisting that C-sections prevent infants from obtaining the “good bacteria” that they previously acquired during vaginal birth. If there is one thing that we can say for sure, it is that the microbiome of the female genital tract is nothing like it was 10,000 years ago, or even 1000 years ago, because no microbiome is like it was 10,000 years ago or even 1,000 years ago. Bacteria evolve far more rapidly than humans and the idea that there are “perfectly designed” vaginal flora that are “perfectly designed” for the infant gut is nothing short of absurd.

The bottom line is that in the game of evolution, she who has the most living descendants wins. There are no extra points for vaginal birth, or breastfeeding, or any other attempt to emulate our foremothers. The woman who has lots of C-section born, bottle fed, fully vaccinated children who survive to reproduce is the winner. That woman is “perfectly designed” for the environment in which we live. Everyone who is obsessed with trying to emulate our hunter-gatherer past is much more likely to be a loser.

A birth activist once told me that she had heard Judith Rooks express regret for undertaking a study on VBACs in birth centers. Rooks had been confident that the study would show that it is safe to have a VBAC in a birth center, but it showed the opposite. Prior to the study, VBAC was considered a reasonable option for birth centers; after the study it was prohibited. Yet even though she was disappointed with the results, even though they showed the opposite of what she had wanted to show, she published them anyway, because that’s what ethics requires.

I don’t know if the story is true, but it was one of the first things I thought of when listening to Rooks testify before the Oregon legislature about the appalling rate of death at the hands of Oregon homebirth midwives (8X higher than the death rate in the hospital). She sounded deeply grieved to have to report that homebirth, which she supports, is unsafe as practiced by Oregon homebirth midwives, yet she reported it anyway, because that’s what ethics requires.

Her testimony highlights the profoundly unethical behavior of the Midwives Alliance of North America (MANA), Melissa Cheyney, and the midwifery hierarchy of Oregon. All three conspired to commit what amounts to fraud: for many years they have been deliberately hiding that homebirth with a homebirth midwife has an appalling neonatal death rate both in Oregon and in the country as a whole. It is the midwifery equivalent of the Vioxx debacle. Although the hierarchy at the Merck drug company was aware that the pain killer Vioxx increased the risk of death from heart attack and stroke, they marketed it anyway. They took the position that it was more important to make money from Vioxx than to protect consumers. It eventually caught up with them. To date, Merck has paid out billions to the thousands of families of those who died as a result of taking Vioxx.

MANA, Melissa Cheyney and other homebirth midwifery executives have knowingly and deliberately taken the position that it is more important to be able to work as homebirth midwives than to protect mothers and babies. In many ways, the case for hiding the appalling death rates at homebirth is more compelling economically than the case for bringing Vioxx to market. While Vioxx represented a significant share of Merck’s income, it was no where near 100% because they have many other products. In contrast, homebirth midwifery usually accounts for 100% of the income of homebirth midwives. Revealing the truth about homebirth deaths would have a major impact on the ability of homebirth midwives to attract clients and make money.

I suspect, though, that money was not the only or even the primary motivation behind the unethical behavior of Melissa Cheyney and MANA.

We are currently immersed in a virtual epidemic of unethical behavior among scientific researchers. It is so easy and so tempting to report fraudulent results that it happens all the time. Partly it is the tremendous pressure to publish scientific papers, but often it is the result of a researcher believing so profoundly that his theory is correct that he (or she) feels no guilt about “massaging” the data to support the theory. They don’t believe that they are committing fraud because they are sure that future data will ultimately prove them right, but they can’t wait for future data because people can benefit from the theory now. Couple that with the fact that scientific journals rarely demand that a finding be reproduced before publication and you have the perfect formula for the plethora of scientific papers routinely published even though they are junk.

I have no way of knowing, of course, but I suspect that something similar has been going on at MANA. It started in 2005 with the Johnson and Daviss BMJ paper that claimed to show that homebirth was safe even though the data showed that homebirth nearly tripled the risk of neonatal death. And it has continued ever since with Melissa Cheyney and MANA waiting desperately for the data that would show homebirth to be as safe as they know it is. That data never came because homebirth midwives are grossly undereducated, grossly undertrained, unsafe practitioners. The longer they waited for confirmation of what they believed, the more they were required to contort themselves to hide the data they had. One thing is sure: they demonstrated consciousness of guilt by deliberately hiding the information from American women.

Many of their tactics over the years demonstrated their consciousness of guilt, but none more so than the decision to share the data only with those who, after being appropriately vetted, would sign a non-disclosure agreement complete with legal punishments for those who shared the data with anyone else. In other words, they understood that the death rates were so hideous that they had to take the incredibly heavy handed and revealing step of announcing legal punishments with anyone daring to share the truth with American women, the one group that was most entitled to have the information.

It appears that MANA, Melissa Cheyney and the midwifery hierarchy never considered their ethical obligations, and not just their obligation to release the data. Almost any other professional organization, when confronted with the evidence that their practitioners were responsible for an appallingly high death rate, would have instituted plans for improving outcomes. It seems never to have crossed the minds of Cheyney and others in MANA. Babies dying preventable deaths? Sad, but apparently a small price to pay for the freedom to be a pretend “midwife” and charge women for services that are apparently literally worse than nothing. The folks at Merck having nothing on Melissa Cheyney and MANA when it comes to the cold blooded sacrifice of innocent people (babies, no less) on the alter of expediency.

Now, of course, their efforts to hide data have been eclipsed by states collecting their own data and they have no one but themselves to blame. As I have written in the past, the biggest mistake that homebirth midwives ever made was their campaign to obtain licensure. They didn’t want to do it, but they wanted insurance reimbursement so badly (and insurance companies will only reimburse licensed practitioners) that they took the risk and it has blown up in their faces. You can fool some of the state legislatures some of the time, but not all of them, and it is hard to fool insurance companies at all. It was inevitable that they were going to demand data, and collect it themselves if need be. Now that data is coming in and it is very, very ugly. What insurance company is going to be willing to reimburse providers that have appalling death rates and, almost certainly, appalling injury rates? And birth injuries are not cheap. They can cost hundreds of thousands of dollars in acute care (think head cooling to minimize neonatal brain damage) and millions in chronic care for those left permanently impaired.

Judith Rooks modeled ethical behavior for midwives and it would behoove them to follow her example and release the data they are hiding and take the steps necessary to improve safety. I have little hope that will happen. The way I see it, the disclosure of the appalling death rates is not the end for the CPM credential, although I suspect that is where it will lead us. Rather, like Winston Churchill once said in another context:

Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.

It is the end of period in which homebirth midwives were able to hide the dead babies, and, as such, marks an important turning point toward the inevitable abolition of the CPM credential. CPMs are not eligible for licensure in any other first world country. It is time to insist that they are not eligible for licensure in the US, either.

Moments ago, the State of Oregon released the official homebirth death statistics for 2012 and they are worse than my worst prediction.

You may recall that back in August 2010, Melissa Cheyney, the Director of Research for the Midwives Alliance of North America (MANA) and also the head of the Board of Direct Entry Midwifery, rejected a call by the State of Oregon for access to the MANA homebirth death rates for Oregon. As a result, the State decided to collect the statistics themselves. They turned to Judith Rooks, a certified nurse midwife and midwifery researcher who is known to be a supporter of direct entry midwifery, to analyze the Oregon homebirth statistics for 2012.

Rooks testified this afternoon at a legislative hearing on HB 2997, a bill addressing the licensing requirements direct entry (homebirth) midwives.

She began by introducing herself:

I’m a certified nurse-midwife, a past-president of the American College of Nurse-Midwives, and a CDC-trained epidemiologist who has published three major studies of out-of-hospital births in this country.

In 2011 the Oregon House Health Care Committee amended the direct-entry midwifery—“DEM”—law to require collection of information on planned place of birth and planned birth attendant on fetal-death and live-birth certificates starting in 2012.

Oregon now has the most complete, accurate data of any US state on outcomes of births planned to occur in the mother’s home or an out-of-hospital birth center.

She then presented and explained the following table:

The death rate is horrific, even AFTER Rooks inappropriately eliminated the death of a baby at homebirth who had congenital anomalies. Since the hospital group contains congenital anomalies, it is not appropriate to remove them the homebirth group.

The total mortality rate associated with those births [planned OOH births with direct-entry midwives as the planned birth attendants] – excluding the one involving congenital abnormalities – is 4.8 per 1000.

For comparison, data on births planned to occur in hospitals is provided in the bottom row of the table.

The real death rate for planned homebirth with a direct-entry midwife in 2012 was actually 5.6/1000.

As Rooks regretfully acknowledges:

Note that the total mortality rate for births planned to be attended by direct-entry midwives is 6-8 times higher than the rate for births planned to be attended in hospitals. The data for hospitals does not exclude deaths caused by congenital abnormalities.

Many women have been told that OOH births are as safe or safer than births in hospitals…

But out-of-hospital births are not as safe as births in hospitals in Oregon, where many of them are attended by birth attendants who have not completed an educational curriculum designed to provide all the knowledge, skills and judgment needed by midwives who practice in any setting.

After reaffirming her support of direct entry midwives, Rooks pleads for more stringent standards:

The legislature won’t have another opportunity to make the law stronger on behalf of safety until 2015. Please keep the six women who lost their babies last year in mind as you legislate this year.

We can only hope that the legislators heed Rooks’ plea. The first two basic steps that they should take are these:

1. Mandate that Oregon homebirth midwives advise women, as part of obtaining informed consent, that homebirth has a death rate 8x higher than hospital birth.

2. Refuse to expand homebirth midwives’ scope of practice and limit them to attending ONLY the lowest risk births.

It’s the least they can do for the women and babies of Oregon.

One of the best things about running this blog is the delight of witnessing women and men discover that they are great writers while engaging with each other in the comments section. Here is a fabulous example, written by thepragmatist in response to my post Natural childbirth, attachment parenting, and policing women’s bodies.

I told my husband that he would be a feminist by the time I was done having our child. He didn’t believe me. I thought I would educate him on the politics of birth… You know, the evils of over-medicalized pregnancy and obstetric interference. Oh boy, it was not him who was going to get the education. No.

What I didn’t know was that I would not be prepared for the loss of agency over my body: that my body would become public property and that I would also feel such despair and horror at the loss. I never realized when I walked into a midwife’s office to plan a home birth (and went home with Birthing From Within that day in my bag to read) that I would end up choosing a MRCS months later, because I realized it was right for me and safe for my baby. That I would meet a female OB/GYN who had utmost respect– more than anyone else– for my agency as a woman, changed my mind about obstetrics forever, and would become a fundamental part of my healing from other trauma. So much for the sexist OB/GYN disabusing the woman of her right to empower herself! Indeed, it was the OB/GYN who was instrumental in helping me understand what it was I really wanted and then manifesting it with me… Certainly not the midwife who told me “not to think about tearing because we have ways to prevent it” or the other midwife, who when I was having strong, regular contractions right before my c-section, told me, smugly, “Well, you can’t always have the birth you want” and refused to attend me and told me to go back to bed. No, midwifery didn’t empower me, science did. Science and reason. Control over my body. A physician with the real power to make that happen.

I learned, on encountering the world of lactivism and attachment parenting that I had assumed would be a good fit for me, as I imagined both feminist, that I was not good enough, not mom enough, not enough, no matter what I did. And that my experience as a woman engaged in the act of mothering was irrelevant to the discussion. I learned that NCB and AP were not only prescriptive but also fundamentally ablest. The final breaking point was when I — disabled by a number of issues — fought my way through many challenges only to be ridiculed for my parenting choices, again and again, some very hard to make. I realized I did not matter as a human being anymore in that context. And that the worse enforcers of this dogma were women themselves. They continue to be. At times derided for such things as “long science-fueled posts” or “normalizing c-sections” and my posts deleted if I dared tried to publicly support a woman in learning to appropriately supplement with formula or enjoy the birth of a child through c-section, for example. Asked to leave our community board for continuing posting “facts” when others would post inflammatory articles like, “Just Say No to Pitocin” and I would go, “Uh, yeah, but wait…” At one point I had 40 grown women devote a thread to informing me that I had completely ruined their forum, when I refused to leave it out of principle, having broken no rules. Later, those women went on to make a different forum where they screen people very carefully for access with intrusive questions to make sure they are sufficiently NCB/AP and topics such as combo feeding or sleep training are off the table, at all times. Sounds feminist to me… Worse yet is knowing that because they pass themselves off as feminist and evidence-based they lure in unsuspecting mothers-to-be who they then fill with misinformation about birth and parenting. Then later, my OB/GYN gets to deal with these women when they show up from home birth a train wreck and be demonized in the process. Avoided interventions but come out of it with perhaps an unnecessary c-section or a needlessly traumatic birth. But who needs to make good sound decisions based on at least a basic understanding of your own physiology, birth, and the interventions involved, and their risks and benefits, when you could sit in an echo chamber all day and blame obstetric intervention and read the same five books to each other?

Indeed, it was MY feminism most altered in its trajectory as I made controversial or unaccepted choices with my body and my baby, meeting my own and my child’s needs, being shamed and derided through out, realizing more and more I had been lied to, that the data was skewed, and that the story was rife with inconsistent, contradictory values, unrealistic (at times, inhumane) expectations and glaring misogyny. Religion, not science. Not safer. Not best practice. Lies. Nefarious too, because the major enforcers of NCB/AP in our community know that they are lies, and have confessed to me in private they know they are lies. Then I fully appreciated the anti-intellectualism but also how corrupt and anti-woman it really was. It wasn’t that my facts were incorrect, but that they were not in line with NCB/AP dominant paradigm. My facts were indeed, not the issue, they were perfectly true: they just did not want them shared.

I was naive, to be honest. I had not ever experienced women en masse, of my own age, in such an environment. Member of many topical message boards over the years, where evidence and argument were critical to discussion, this was so foreign to me that I could not understand it. Why would you not want to know what was going on in your body or how to improve your own medical care? And how could these, the birth duolas and educators, shut me down so completely, when they knew I was correct? Cynically, my husband pointed out I was embarrassing them in front of their client base. “But it’s still a lie!” I would shout. He was right. Correcting the “birth educators” on their misinformation was embarrassing for them, so they demonized me.

My husband did, indeed, become a feminist. He is proud to call himself a feminist. he became a feminist not because I educated him about Spiritual Midwifery. He walked with me through making enormous strides as a woman. From my MRCS came the first time in my life I felt power over my own body, as a sexual abuse survivor, and from there, so much more power came. In the moment that I said no to a vaginal birth and someone actually said, OK! I took new control over my body, my sexuality, my needs as a woman. A pivotal moment in my life. And I am told that I was powerless there. Oh no, not at all. Far from powerless. From there the seeds grew to face ALL the misogyny in my life around me and I stopped accepting anti-feminism from other people. I began to see that other women are the real enforcers in a way I never realized. Or wanted to realize. From there-in everything shifted. When my son was just about a year old, I walked into a police station and filed a report against a charismatic and popular serial sexual predator, thereby stopping him from hurting anyone else again, but risking the same social shunning. Yet I am not good enough for these women, because I fed my baby formula sometimes? I am not powerful? I am ten times braver, indeed. Women who are empowered do not need to empower themselves through their reproductive function or prove their worth through mothering. I learned that bit here.

It has redefined me. But it also makes me feel like a lone wolf, because I have been ostracized for my choices: from decrying the current parenting paradigm; for actually wanting to talk about the needs of mothers as human beings and not objects; and of course, worse of all, to suggest that women have the right to do what they need to do with their own bodies and have access to accurate information so they know what choices may be right for them. It has resulted in the kind of shaming and shunning usually reserved for promiscuous women or victims of sexual assault. Having also been that woman more than once, it feels the same to me. But never have I been so shamed as when I stood up for mother’s rights! Something you think would be fairly non-controversial, given how much those in the NCB movement promise women such rights in childbirth (and do not deliver), but those rights apparently end there. Because once baby is born, mother has no needs. Huge realization there that I was not actually with feminists. I’m not talking about mothers who “need” to neglect their children, but rather, that it is okay to take into account your own feelings and needs: indeed, it is critical. And indeed, it is the very same kind of shaming, and policing of women’s bodies: through shame and shunning the NCB and AP movement actively silent dissent and enforce prescriptive and gendered parenting roles. At one point, my husband got angry at the continual characterization as men as hapless idiots, incapable of nurturing. He is more of a nurturer, in spirit, than me.

It is really interesting how oppression of women is a continuum and central, always, is reproduction and the reproductive years. So it’s not shocking, really, when a nearby crisis pregnancy center puts on a NCB movie night to raise money to fight abortion and the feminists in the room can’t seem to put it together. Do they say hurrah or get angry? No, they say nothing at all. Eye opening! All around me women call themselves feminist and embrace this movement and they do not know what it is they are subscribing to. This week a film on Ina May is being screened at our local college. Facebook is abuzz. And I want to post, “Did you know she let her premature baby die for lack of medical care? Do you know she doesn’t understand basic female anatomy? Do you know that she judges women’s ability to birth on their emotional state? Why is this feminist? Don’t call it feminist. Call it whatever else you like, but not that.”

I know it would just be deleted.

The disenfranchisement of women’s right to their own bodies is not what I envisioned. I totally bought it: that it was a movement to liberate women. And I think in my mother’s time, maybe it was. They fought for maternity leave, rights in the workplace for mothers, and legalized abortion. But our fight for reproductive freedom has been hijacked and, in a sense, truncated. Misinformation and out right deceit regarding pregnancy and birth is rampant. The real risks of birth rarely discussed. And although we have the right to decide to end a pregnancy, the right to effective pain relief in labour and maternally-requested c-section are tenuous in many Western countries where other feminist principles are often adopted and extolled. The cultural and ideological creep is no longer creeping here in Canada: it is a tsunami, and there is very little push back from my feminist peers. Piggy-backing on the work of a generation of feminists who fought for reproductive rights, inserting itself into discussion on autonomy when it is exactly the opposite, and so many following blindly and unaware of its greater implications.

Yesterday I wrote about the efforts of natural childbirth advocates, lactivists, and attachment parenting advocates to police women’s bodies through pregnancy and the early childhood years.

Surely, I thought, there must be a women’s organization that defends against this attempt to control pregnant women’s bodies, and there is. There’s just one problem. They’re only interested in protecting women who make approved choices and — surprise! — the only approved choices are those championed by NCB advocates, lactivists, and attachment parents.

The organization is called National Advocates for Pregnant Women (NAPW), but they ought to include an asterisk in their name. They don’t advocate for all pregnant women, just a small subset.

NAPW describes themselves as follows:

National Advocates for Pregnant Women (NAPW) seeks to protect the rights and human dignity of all women, particularly pregnant and parenting women and those who are most vulnerable including low income women, women of color, and drug-using women. NAPW uses the lessons learned from the experiences of these women to find more effective ways of advancing reproductive and human rights for all women and families. Our work encompasses legal advocacy; local and national organizing; public policy development, and public education. NAPW is actively involved in ongoing court challenges to punitive reproductive health and drug policies and provides litigation support in cases across the country. NAPW engages in local and national organizing and public education efforts among the diverse communities that are stakeholders in these issues, including the women and families directly affected by punitive policies, as well as public health and policy leaders.

Consider their page devoted to birth issues: unhappy with your maternity care? unhappy with your C-section? committed to breastfeeding? They’ve got your back.

Denied a maternal request C-section? Forced to sign a waiver simply because you don’t want to breastfeed? Fuggedaboutit!

NAPW was front and center in the defense of the Florida woman who wanted to postponed by several days her medically indicated semi-emergent C-section for fetal distress.

NAPW has sent a letter to the hospital explaining that the threat of arrest lacks justification in both law and medical ethics. Farah Diaz-Tello, NAPW Staff Attorney explained, “Women do not lose their rights to medical decision making, bodily integrity and physical liberty upon becoming pregnant or at any stage of pregnancy, labor or delivery.”

Sounds to me like the right to medical decision making would include maternal request C-sections. But that’s not what you find when you search the site. The only reference to maternal request C-section (cavalierly referred to as C-section “on demand”) is this mention from 2006:

…organizations concerned about unnecessary and potentially risky c-sections, including NAPW, will be closely watching this week when the National Institutes of Health state-of-the-science holds its conference on ‘cesarean delivery by maternal request.’

So let’s see if I get this straight. An organization that supports a women’s rights to refuse C-section, citing the right to of women to control their own bodies, is staunchly opposed to women’s right to request a C-section, ignoring the right of women to control their own bodies. They have a word for that stance: hypocrisy.

If I understand NAPW correctly, they believe that women have the right to weigh the risks and benefits to themselves and their children of medically indicated C-sections, but somehow are incapable of weighing the risks and benefits to themselves and their children of maternal request C-section. And that, of course, makes no sense.

If NAPW is so concerned about the right of women to control their own bodies, why aren’t they front and center in opposition to new rules banning elective delivery before 39 weeks? Surely if a woman has a right to control her own body, she has a right to control how long she wishes to be pregnant. Surely if a women has a right to bring an abortion, which is the termination of a pregnancy before viability, she must have a right to terminate a pregnancy that will result in a healthy, live baby.

Surely if a woman has a right to control her own body, she should not be forced to sign waivers attesting to the superiority of breastfeeding when she chooses not to breastfeed. How is that any different from the many different hoops anti-choice forces want to impose on women seeking abortion?

The ultimate irony is that NAPW supports women in their choice to use recreational drugs during pregnancy:

Some of the starkest examples of the consequences of denying women full human rights involve the direct and severe punishment of pregnant, drug-using women. By combining claims of fetal rights with the war on drugs, new laws that punish pregnant women and families are being put into place… Like other applications of the war on drugs, the punishment of pregnant women is targeted at vulnerable, low-income, women of color; those with the least access to health care or legal defense.

In the last twenty years, over 200 pregnant women or new mothers have been arrested in a concerted effort to deny women liberty. At least nineteen states now address the issue of pregnant women’s drug use in their civil child neglect laws, and many of these states make it possible to remove a child from the mother based on nothing more than a single positive drug test. These cases and statutes are having a devastating effect on public health efforts, as well as women’s reproductive rights, drug policy reform efforts, and efforts for racial equality.

So if I understand NAPW correctly, they will fight for your right to use heroin while pregnant, but if you want to have a maternal request C-section to preserve your pelvic floor, you’re on your own.

Women do have a right to control their own bodies and that right extends not merely NAPW approved choices (having an abortion, refusing a C-section, or using heroin during pregnancy). It extends to ALL choices whether the women in NAPW would choose the same things for themselves or not.

NAPW is inappropriately named. They don’t advocate for pregnant women. They only advocate for pregnant women who make choices they approve, and that is hypocrisy of the worst kind.

It is a sad fact of history that men have spent a tremendous amount of time policing women’s bodies. And an even sadder fact is that women have often been the prime enforcers in this effort.

Consider female genital mutilation. It is a practice designed by men, for men, to preserve men’s privileges, but it is performed exclusively by older women on female children in order to make their bodies “respectable” for men.

You might think that the time of women as enforcers of policing other women’s bodies has passed. You’d be wrong. There are now entire movements devoted to policing women’s bodies: the natural childbirth movement, the lactivist movement, and the attachment parenting movement.

In fact, with the exception female genital mutilation itself, it is difficult to think of a historical movement that placed more emphasis on the insistence that women use their bodies in the “proper” way. These philosophies are the intellectual equivalent of the burqa. They function in large part to keep women trapped in the home, invisible, and incapable of pursuing the same goals as men.

I recently had something of an epiphany. I’ve been maintaining a version of this blog for more than 6 years. There have been literally hundreds of thousands of comments in that time. The epiphany is that most of them have been in response to, or in defense of what women should or should not be doing with their bodies. Should women experience pain in labor? Do they have a right to abolish that pain? Should women breastfeed? Should women persevere if they have pain or difficulty in breastfeeding? Should women feel free to supplement or replace breastfeeding with formula? Should women carry their infants around all day? Should women have their children sleep in the marital bed each and every night?

This blog is noted for its full throated condemnation of the myths and lies of the homebirth and natural childbirth movements, and emphasizes the fact that homebirth results in preventable neonatal deaths. But I’d like it to also be noted for something else: the firm conviction that NCB, lactivism and attachment parenting are anti-feminist. All three locate the center of women’s worth in her body (specifically her vagina and breasts) and generate elaborate prescriptions for women’s use of their own bodies that essentially control how they use their bodies every minute of every day. I firmly believe that women’s bodies should be controlled by women themselves, not by groups who prescribe the “correct” way to give birth, the “correct” way to nourish a baby, and the “correct” way to nurture a baby.

I’ve joked about the sanctimommy who has advice for everyone on every aspect of mothering. I’ve pointed out that a great deal of the appeal of being a part of the NCB, lactivism and AP movements is the opportunity to feel superior to other mothers, and to belong to a like minded community whose primary purpose seems to be praising themselves. Yet that is merely the incentive to joining these movements, not the purpose of them. The true purpose, sometimes conscious and sometimes unconscious, is to generate so many prescriptions around mothering that women cannot possibly leave the home and participate in the larger world.

It’s hardly a coincidence that the prime movers behind these philosophies are men, particularly men deeply disturbed by the idea of women rejecting the conventional roles to which men have relegated them. From Grantly Dick-Read, the father of natural childbirth, a sexist who decried women’s efforts at political and economic emancipation, to Dr. William Sears, the father of attachment parenting, who is a religious fundamentalist, these efforts at policing women’s bodies began with the ideas and efforts of men.

And I suspect that it is hardly a coincidence that the leading female enforcer of policing pregnant women’s bodies is Ina May Gaskin. She’s a woman in the shadow of a man who is not merely her husband,  but the leader of the cult (The Farm) to which she belongs. Based on her own admission, she was pressured into letting one of her own children die at homebirth because her husband did not want to use the medical system when that baby was born prematurely, on a bus on the freezing Great Plains, in the dead of winter. She was relegated by her cult to the “women’s work” of midwifery, and she has done a fabulous job of making that work important. But no one should ever forget that Ina May Gaskin was relegated to midwifery, and that the only control she was allowed to have was control over other women.

In an ironic twist, the current enforcers of these movements have turned to men to make the job of enforcement easier. New York Mayor Michael Bloomberg’s bizarre effort to promote breastfeeding by shaming women who want to use formula is a case in point. In first world countries, the public health benefits of breastfeeding, while real, are trivial. Yet lactivists have convinced Mayor Bloomberg and his staff that it is their right and their obligation to put obstacles in the path of women who don’t want to use their breasts to feed their babies.

Lactivists have created the Orwellian designation of “baby-friendly” hospitals to force women into signing waivers explicitly stating that those who refuse to use their breasts to feed their babies are knowingly choosing an inferior method of caring for them. Can you imagine the howling from the NCB movement if every woman who came to the hospital with a birth plan for avoiding interventions was forced to sign a statement acknowledging that childbirth without interventions was an inferior, and less safe, method of birth? Yet many of these same women seem to positively gloat at the idea of other women metaphorically branded as lesser mothers simply because they refuse to use their breasts in the approved manner.

I tend to focus on the validity of the claims of the NCB, lactivism and AP movements. It’s easy to do so since most of their empirical claims are factually false. However, we shouldn’t forget that these movements are, at their heart, retrograde, anti-feminist and ultimately concerned with policing women’s bodies.

Make no mistake: there is nothing wrong with unmedicated childbirth, breastfeeding or attachment parenting if those are the choices that work best for individual women and their families; I chose to do all of them with my own children. But there is something very wrong with philosophical movements devoted to forcing those choices on other women, essentially policing their bodies for every moment of the 9 months of pregnancy, the hours of labor and childbirth, and the years of parenting small children.

Let me take you on a trip down memory lane.

I started writing about the Midwives Alliance of North America and their campaign to hide their death rates more than 5 years ago, back in August of 2006. My first major post on the issue was Research and special interests/the BMJ 2005 study in which I began an exploration of the fact that Johnson and Daviss were not forthcoming about their connections to the homebirth industry. Over the following year, I proceeded to analyze the BMJ 2005 study and demonstrate that it actually shows that homebirth with a CPM in 2000 had a death rate nearly triple that of low risk hospital birth in the same year. It took nearly 2 years, but Johnson and Daviss ultimately acknowledged that I had been right all along.

I first wrote about the fact that the Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, was hiding their own death rates back in January of 2007. MANA has fought me every step of the way, denying, lying and doing whatever it takes to hide the fact that not only does the evidence show that homebirth with a homebirth midwife has a hideous death rate, but MANA has known that for years and done everything it could to make sure that American women did not find out.

That hideous death rate has been confirmed by 5 years of CDC statistics on planned place of birth, and most spectacularly by the horrific perinatal death rate of licensed Colorado homebirth midwives.

The mountain of statistics confirming the increased risk of death at homebirth is continuing to grow, and, as a result, it appears that 5 years of lying and denying on the part of MANA and homebirth midwives and their supporters is about to end. That’s the message I take away from the proactive attempts of the homebirth industry to minimize the significance of those deaths. Consider today’s post on Science and Sensibility by by Wendy Gordon, CPM, LM, MPH, MANA Division of Research, Assistant Professor, Bastyr University Dept of Midwifery (and placenta encapsulation specialist!), a woman who has been arguing with me in print about the data for more than 5 years.

The post talks about last week’s Institute of Medicine conference on birth settings and specifically addresses data that shows that planned homebirth has an increased rate of death. Instead of denying it, as Wendy Gordon has done in a variety of venues for more than 5 years, she actually acknowledges it and then counsels everyone to ignore it.

Gordon references the presentation by Dr. Frank Chervenak on CDC data:

Chervenak used his 12 minutes (out of 10) that were to be devoted to the hospital provider perspective for, instead, a rapid-fire display of “back-of-the-envelope” bar graphs attempting to show home/hospital differences in 5-minute Apgar scores using raw data drawn from birth certificates.

Gordon helpfully telegraphs the response that I suspect will accompany MANA’s defense of its horrific death rates:

1. It hasn’t been published!

Since it appears that some doctors are having a hard time getting their “research” on this topic published in peer-reviewed journals, they are presenting their data in settings that do not require peer-review, such as last year’s annual conference of the Society of Maternal-Fetal Medicine (the study still hasn’t been published) and this IOM workshop.

Of course, CDC data is published. It’s published by the CDC. It is valid even before it is included in a peer reviewed scientific paper. When the CDC publishes the number of people who died of lung cancer last year, that number is accepted, regardless of whether it ever appears in a scientific paper.

2. So what if the death rate at homebirth is much higher? The absolute number of babies who have died is small.

Let’s say that a person’s odds of getting struck by lightning in a heavily populated city are one in a million, and those same odds in a rural area are five in a million. These odds are called your “absolute risk” of being struck by lightning. Another way to look at this is to say that a person’s odds of being struck by lightning are five times higher in a rural area than in a densely-populated area; this is the “relative risk” of a lightning strike in one area over another.

A common approach of anti-homebirth activists is to use the “relative risk” approach and ignore the absolute risk, because it’s much more dramatic and sensationalistic to suggest that the risk of something is “double!” or “triple!” that of something else …

So after years of lying about the increased risk of death at homebirth, the homebirth industry is finally acknowledging that what I’ve been writing about the death rates has been true all along.

I find it quite amusing that Gordon and other homebirth advocates have suddenly discovered the difference between absolute and relative risk. The same people who have been howling about the “dangers” of epidurals (the risk of death from an epidural is less than the risk of being killed by a lightening strike), are suddenly insisting that the risk of death at homebirth, which is anywhere from 100 to 1000 times higher, is actually so small that you should ignore it.

3. Birth certificate data is unreliable!

Epidemiologists in the room were quick to step to the microphone for the open discussion part of the panel, pointing out the many flaws in Chervenak’s presentation. Marian MacDorman, Ph.D., senior statistician and researcher for the CDC’s National Center for Health Statistics, reminded everyone that birth certificate data is notoriously unreliable for neonatal seizures and low Apgar scores; this has been shown time and again for decades and had indeed been discussed earlier in this very workshop. More importantly, McDorman stated that data from birth certificates cannot be used to make comparisons between settings or providers…

I find that absolutely hilarious. Marian MacDorman, an editor of the Lamaze sponsored “journal” Birth, has published a number of papers based on, you guessed it, birth certificates. Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with “No Indicated Risk,” United States, 1998–2001 Birth Cohorts is widely quoted in the homebirth community as demonstrating a 3X higher neonatal death rate (triple!) for elective C-section as compared to vaginal delivery. MacDorman and colleagues publicly revised the relative risk after others pointed out serious methodological flaws, but they still ended up claiming that C-section without medical indication has a 1.5X higher risk of neonatal death (nearly double!) than vaginal delivery. But birth certificates are notoriously unreliable for reporting risk factors, as I pointed out at the time.

Apparently MacDorman is trying to set a new standard for hypocritical behavior. She published at least 2 studies relying on birth certificate data, and in both studies, although the relative risk of neonatal death at C-section was supposedly nearly double or triple, the absolute risk was very small. Those studies are supposed to be valid, but the homebirth death rates are not?

After years of lying and denying, homebirth advocates are being forced to acknowledge the dramatically increased risk of death at homebirth.

There are two important messages to take away from this:

Homebirth (particularly homebirth at the hands of grossly undereducated and undertrained CPMs) dramatically increases the risk of perinatal death.

More importantly, professional homebirth advocates have steadily and repeatedly lied about the increased risk of perinatal death. They should never have been trusted before, and cannot be trusted now.

This is yet another reason why the CPM should be abolished. In addition to being undereducated and undertrained, the entire CPM industry is unethical, putting their desire for income ahead of their obligation to obtain informed consent. Not only have they let babies die, they’ve lied about it, too.

Imagine if an ophthalmology organization created a “eye friendly” policy that recommended, as a first step, shaming people who need glasses.

Imagine if said organization mandated that before opticians could grind the lenses, the patient was required to sign a release stating that although she knew that natural vision was best, she was insisting on artificial vision.

How about if the organization insisted that every pair of glasses was required to carry a warning label stamped on the ear piece declaring that glasses are a poor substitute for natural vision?

And imagine if that organization recommended weeks of stumbling about without glasses in an effort to improve vision “supply” to meet with vision demand.

We would consider that organization to be made up of fools whose primary impulse was to demean those who need vision correction.

Under no circumstances would we consider such policies to be “eye friendly” and we certainly wouldn’t consider them to be patient friendly.

So why do we allow lactivists to promote similar policies?

In a recently published opinion piece in Obstetrics and Gynecology, Is Breast Always Best?: A Personal Reflection on the Challenges of Breastfeeding, obstetrician Divya K. Shah argues for a less demeaning approach to discussing breastfeeding.

Dr. Shah describes her history of infertility and her commitment to breastfeed the child she ultimately conceived:

… [I] was looking forward to the immediate “skin-to skin” contact I had been taught would facilitate breastfeeding. The joy I had anticipated when my daughter latched on, however, was replaced by searing pain. It was normal, I was told, my breasts just needed to “toughen up.” Two days later, I was still shouting expletives through every feed, and the baby had lost more than 15% of her body weight. I was told she had a tight frenulum, or “tongue tie,” that was causing a painful, ineffective latch. The pediatric otolaryngology fellow performed a frenulectomy the next day— and although my pain improved, my milk production did not. The hospital pediatricians instructed me to supplement with formula. Before I could do so, our hospital asked me to sign a release stating that I knew that breast milk is the very best form of nutrition but that I had nonetheless chosen to deviate from the practice of exclusive breastfeeding. I cried as I signed the form, feeling like I had let my baby down before even taking her home from the hospital.

Apparently the hospital was “baby-friendly” and in the wisdom of the lactivists who control the baby-friendly appellation, shaming is an integral part of promoting breastfeeding.

Despite heroic attempts to continue breastfeeding, it became clear that Dr. Shah was not producing the amount of milk her baby needed.

Dr. Shah believes that she learned something important about the experience of patients:

It took my recent experience as a patient to make me realize that there is a group of women whom we as practitioners are inadvertently alienating—the mothers who, despite motivation, persistence, and utilization of all available resources, are still unable to breastfeed. Is continued reinforcement that “breast is best” helping this population? Many of these women are already
self-flagellating and facing judgment from family and friends—do they truly benefit from the additional scrutiny of their physician? Or, by promoting the idea of breastfeeding as an ideal of motherhood, are we as a community simply reinforcing the feelings of anxiety, guilt, and inadequacy that inevitably plague new mothers? …

As I’ve written many times before, there is no evidence that “baby friendly” hospital policies increase breastfeeding rates. The only thing they appear to do is increase the rate of women who claim, on hospital discharge, that they will be breastfeeding, but don’t follow through.

The sad reality is that we’ve allowed public health policy to be highjacked by a bunch of activists who exaggerate and misrepresent the scientific evidence about breastfeeding to promote the validation of their personal choices. “Baby-friendly” hospital initiatives are misnamed. It would be more appropriate to call them “lactivist-friendly” since the only thing they reliably do is make lactivists feel good about themselves and their own choices. No program can be “baby-friendly” if there is no evidence that it works, if it does not address the real issues, and if it shames and denigrates the mothers of those babies.

Dr. Shah ends with a plea to her colleagues:

I would like us as members of the American College of Obstetricians and Gynecologists to acknowledge proactively the challenges involved in breastfeeding as well as to normalize the difficulty that many women experience. By describing breastfeeding initiatives as “baby friendly,” the unfortunate implication is that mothers who do not breastfeed are, by default, “baby un-friendly.” Albeit a subtle change in language, I envision a more holistic “family friendly” approach to breastfeeding and postnatal care that takes into account the physical, mental,
and emotional health of both mother and baby, thereby better individualizing the care that we provide to our patients.

Simply put, obstetricians should stop promoting lactivist-approved mother-shaming, and get back to promoting the welfare of both babies and mothers.