The folks at Latch On NYC, apparently stung by the large and growing chorus of criticism, are backpedaling as fast as they can.

In my piece for TIME, Breastfeeding Wars: Why Locking Up Baby Formula Is A Bad Idea, I pointed out:

… Most mothers give a great deal of consideration to feeding methods before they have their children — their decisions are not based on their ability to access formula in the hospital. The most likely outcome of storing formula in locked cabinets is shame for mothers who ask for it, and extra, unnecessary work for nurses who have to retrieve it, monitor it and record it…

The plan to lock up infant formula has drawn particular ire and the folks at Latch On NYC are now denying that they ever planned to lock up formula.

Sometime yesterday, Latch On NYC added a page of “Myth and Facts” that, as the name indicates, purports to correct the “myths” being circulated by the critics of the initiative. As demonstrated by the webcache, this section did not exist as recently as 7:38 GMT. The addition is rather deceptive, since the policies that Latch On NYC is now denying are an integral part of its program, remain elsewhere on the website, and were publicly supported as recently as 3 days ago by an official of the program.

For example, the “Myths and Facts” page states:

Myth: The city is requiring hospitals to put formula under lock and key.

Fact: Hospitals are not being required to keep formula under lock and key under the City’s voluntary initiative. Formula will be fully available to any mother who chooses to feed her baby with formula. What the program does is encourage hospitals to end what had long been common practice: putting promotional formula in a mother’s room, or in a baby’s bassinet or in a go-bag – even for breastfeeding mothers who had not requested it.

Myth: Mothers who want formula will have to convince a nurse to sign it out by giving a medical reason.

Fact: Mothers can and always will be able to simply ask for formula and receive it free of charge in the hospital – no medical necessity required, no written consent required.

Yet these claims are directly contradicted by front page of the website as well as the initiative description, which claims that Latch On NYC will:

Limit access to infant formula by hospital staff

Moreover, Deborah Kaplan, Assistant Commissioner of the NYC Bureau of Maternal, Infant and Reproductive Health, appearing with me in a video roundtable on HuffPo, explicitly acknowledged the restrictions. At 9:10 in the video, the host specifically asks Ms. Kaplan whether formula will be locked up (my transcription):

Host: Did I read somewhere that you will have to sign out formula? Perhaps I’m mistaken about that.

Kaplan: Yes, that is correct … and let me explain. I’m glad you asked that question. It’s important to clarify. We are … When a mother comes in and she has decided she wants to formula feed her baby, that is fine; that is her decision. She will not not be made to feel guilty and she will be given that formula. And in … the main change in that situation is that right now formula is available all over the floor where the baby and the mother is and, as some mothers have said, they want … they came in and they wanted to breastfeed and they had a small problem and right away one of the staff may have given her formula instead of providing her support and letting her try to really be successful…

In other words, formula will no longer be easily available, women will have to ask for it and nurses will have to retrieve it.

It appears that Latch On NYC is responding to the massive amount of criticism by disavowing its own words, although not by changing the actual program.

The entire controversy is an object lesson in what happens when a government organization allows itself to be captured by a special interest group. The idea of locking up formula in hospitals, forcing nurses to track it, forcing women to ask for it, and “educating” them when they do, is the ultimate lactivist dream come true.

There’s no evidence that these measures will improve breastfeeding rates, but that has never been a problem for lactivists. They are all about shaming women who do not make the same choices they do. It is deeply unfortunate that Mayor Bloomberg and the NYC Bureau of Maternal, Infant and Reproductive Health allowed themselves to be emeshed in the politics of lactivism. They may be backpedaling as fast as they can, but they only look foolish as a result.

At a dinner party several months ago, one of the guests, a psychiatric social worker, asked me what I do. I explained that I blog about issues of pseudoscience in parenting. She became very excited and asked me if I had ever heard of attachment parenting. She has been seeing an ever increasing number of young mothers with depression and related issues. In her experience, the increase in young mothers with depression is related to the rise of attachment parenting, which appears to dramatically increase levels of stress, feelings of failure and social isolation.

I was reminded of her observations when I came across the paper Insight into the Parenthood Paradox: Mental Health Outcomes of Intensive Mothering by Rizzo et al:

This study was conducted to provide quantitative data on the relationship between intensive parenting and maternal mental health outcomes including stress, depression, and life satisfaction. The first hypothesis was that endorsing intensive parenting attitudes would result in greater levels of stress and depression and lower levels of life satisfaction. Additionally, as Essentialism focuses on the primacy of the mother to the exclusion of other potential helpers in the family, we expected this scale to be related to lower levels of perceived family social support. The second hypothesis was that the endorsement of intensive parenting attitudes would predict maternal mental health outcomes above and beyond family social support, an already well-known predictor of well-being.

How did they measure commitment to attachment parenting?

Recently a quantitative measure of intensive parenting attitudes has been developed. This operationalization identified five factors associated with intensive parenting: Essentialism, Fulfillment, Stimulation, Challenging, and Child-Centered. Essentialism refers to the belief that mothers are the most essential parent; Fulfillment is the belief that parents should feel completely fulfilled by their children; Stimulation involves parents providing consistent intellectual stimulation for their child; Child-Centered refers to the parents’ lives totally revolving around their children; and Challenging refers to the belief that parenting is difficult and exhausting.

They measured depression, stress, life satisfaction and family support using standard diagnostic questionnaires.

What did they find?

The belief that mothers are the most capable parent (Essentialism) was associated with higher levels of stress and lower levels of life satisfaction. In prior research, mothers have expressed difficulty selecting an alternate caregiver because they felt that no one else, including the child’s father, could provide the same degree of love, commitment, and skill. If women believe they are the most capable caregiver, they may limit help from others, a practice known as maternal gatekeeping. This may account for the lower levels of social support reported by women who endorsed essentialist attitudes…

In addition:

The belief that parenting is difficult (Challenging) was related to higher levels of depression and stress, as well as lower levels of life satisfaction. If women believe that parenting is very challenging, they may experience higher levels of stress attempting to cope with the daily demands placed on them as parents. In addition, if women believe parenting is challenging, their feelings of competence as a caregiver may be diminished resulting in decreased well-being. On the other hand, already experiencing higher levels of stress and depression may lead women to view parenting as more challenging. Either way, believing that parenting is challenging, feeling stressed, and being depressed may relate to women’s decreased satisfaction with their lives.

Finally:

Believing that parents’ lives should revolve around their children (Child-Centered) was related to lower levels of satisfaction with life. According to Tummala-Narra, when women feel they must subsume their needs to the needs of their child, they lose a sense of personal freedom, which may result in women experiencing negative mental health outcomes (e.g., lower levels of life satisfaction). In contrast, child-centered beliefs were not related to stress and depression. It is possible that if a woman’s life is child- centered, meeting the demands of her children may not seem too stressful because she has already tailored her life to meet those needs. Thus, a child-centered mother may not experience as much stress related to difficulty coping with life’s demands.

The authors conclude:

The results of this study suggest that the negative maternal mental health outcomes associated with parenting may be accounted for by women’s endorsement of intensive parenting attitudes. So, if intensive mothering is related to so many negative mental health outcomes, why do women do it? They may think that it makes them better mothers, so they are willing to sacrifice their own mental health to enhance their children’s cognitive and socio-emotional outcomes. However, research is needed on child outcomes because, currently, there is not any data to support this assumption. In fact, young children of over-involved or over-protective parents often experi- ence internalizing disorders. In addition, research clearly indicates that the children of women with poor mental health (e.g., depression) are at higher risk for negative outcomes. Given that this study found that aspects of intensive parenting are associated with negative maternal mental health, then intensive parenting may have the opposite effect on children from what parents intend.

This study comes with lots of caveats. It is small, preliminary and it hasn’t been reproduced. The issues that it raises, though, are serious and worthy of further study.

There has never been any scientific evidence to show that attachment parenting is better for children, and now there is evidence that it is worse for mothers. It may allow them to flaunt a sense of superiority, but apparently that isn’t to stave off feelings of depression, stress and decreased life satisfaction.

If you can’t access the embedded video, you can watch it here.

Here’s what they saying in support of New York City Mayor Michael Bloomberg’s mandate to encourage breastfeeding by putting formula under lock and key:

• Additional information can help the mother make a fully informed decision.
• This plan does not change a woman’s ability to make her own choice.
• This program is a victory for women and their newborn babies. We thank the Mayor for his work to ensure that women have all the facts.
• Doctors know that breastfeeding is best for babies. Women considering how to feed their infants should be just as informed as doctors.

Wait a second. Did I just write that these comments were made in support of Bloomberg’s Latch on NYC program? Sorry, I got confused. These comments were made in support of the Virginia law that would have mandated vaginal ultrasounds as a condition for terminating a pregnancy. It’s not surprising that I confused the two since both are programs that are punitive, vindictive and actually designed to harass women who make the “wrong” choice.

I mentioned the deeply unfortunate similarities between the two plans during a round table conversation on HuffPost Live 321, the new video section of the Huffington Post. The subject under discussion was “Bloomberg Know Breast” and participants included Deborah Kaplan, MPH, R-PA, Assistant Commissioner of the NYC Bureau of Maternal, Infant and Reproductive Health. The video will be posted sometime today.

As I wrote last week, Bloomberg’s plan to lock up infant formula is completely indefensible.

How on earth could he imagine that treating infant formula like prescription medication is a remotely defensible use of government power? Perhaps he’s been spending too much time in lactivist-land, that fantastical alternate world where breastfeeding is easy, cost free and only undermined by imaginary social and cultural pressures.

But Ms. Kaplan was passionate in her defense of the program. I appreciate her sincerity and I don’t doubt for a moment her commitment to the health and well being of the newborns of New York City. Then again, I don’t doubt the commitment of the anti-abortion community to the well being of unborn babies. In both cases, people in positions of authority want to mandate what they think is best for babies. But in both cases, they grossly overstep the bounds of government authority and trample on the rights of women in the process.

And both groups offer the same defense of forcing women to jump through hoops to access something they already decided they wanted.

1. Additional information can help the mother make a fully informed decision.

Who could oppose additional information? The anti-abortion forces are entirely disingenuous when they insist that the information provided by a vaginal ultrasound will help women make an informed decision. There is not a single woman who isn’t aware that abortion prevents the eventual birth or a baby. The lactivists aren’t being disingenuous. They actually do believe that more women would breastfeed if they had additional information. The problem is that there is no evidence that additional information would improve breastfeeding rates. Lactivists simply prefer that explanation for bottle feeding instead of the real reason, that breastfeeding can be difficult, painful and very inconvenient.

2. This plan does not change a woman’s ability to make her own choice.

Ms. Kaplan was emphatic on this point, but her assurances are as hollow sounding as those of anti-abortion activists who insist that a mandatory vaginal ultrasound does not change a woman’s ability to make her own choice about terminating her pregnancy.

Here’s the problem that Ms. Kaplan refuses to acknowledge. Women who ask for formula have made their choice already. The Bloomberg plan deliberately puts obstacles in the path of women who have already made a choice in the exact same way that mandating vaginal ultrasound puts an obstacle in the path of women who have already decided on termination. In both cases, the government is intervening to pressure women into changing a decision into one that activists approve.

3. This program is a victory for women and their newborn babies.

The reality is that coercive programs like these are victories for activists, not for anyone else.

4. Doctors know that breastfeeding is best for babies. Women considering how to feed their infants should be just as informed as doctors.

This is just a variation on the information gambit. There is hardly a woman alive who is not aware that breastfeeding is considered best, so there is no demonstrable need for them to be informed of this fact every time they try to access formula.

The dangerous similarity between the rhetoric of anti-abortion activists and lactivists should serve as a wake up call to lactivists, to Ms. Kaplan and to the Mayor himself. Most lactivists recognize the tactics of anti-abortionists for what they are: indefensible hoops that women must jump through to access a choice they already made.

To the lactivists behind Mayor Bloomberg’s plan: “Pot meet kettle.”

You are doing exactly the same thing that anti-choice activists do: putting obstacles in the way of women who make choices different from yours. It is wrong for anti-choice activists and it is just as wrong for you.

addendum: I’ve created a Facebook page where we can let Mayor Bloomberg know how we feel.

When my youngest son was small, his preschool decided to introduce a program designed to prevent molestation. Looking over the literature for the program, I couldn’t find any evidence that it had been shown to work. I pointed this out to the principal, who responded: “Amy, education isn’t like medicine. We don’t have to prove that it works before we implement it.”

I’m reminded of that incident when contemplating the WIC program designed to improve breastfeeding rates. I consider the program to be punitive, vindictive and unlikely to accomplish its aims. Moreover, just like the preschool program on molestation, no one bothered to show that it would work before they implemented it.

Now, three years into the program, a paper analyzing the effects of the special WIC rewards for breastfeeding mothers has finally been published. The result: the WIC program is utterly ineffective at increasing breastfeeding rates.

The paper Food-package assignments and breastfeeding initiation before and after a change in the Special Supplemental Nutrition Program for Women, Infants, and Children was published online on July 25, 2012.

There were changes in WIC food-package assignments and infant formula amounts but no change in breastfeeding initiation…

After the change, fewer WIC mothers of new infants received the partial breastfeeding package. More WIC mothers received the full breastfeeding package, but more mothers also received the full formula package.

In fact, the amount of formula used increased significantly:

… When measured as a continuous variable in dyads with infants in the birth month, the mean formula amount increased significantly from 546.8 fluid oz (16,171 mL) before implementation to 559.6 fluid oz (16,549 mL) after implementation (t = 4.36, P > 0.001).

There was no increase in the rate of breastfeeding initiation:

As measured in administrative records, the breastfeeding initiation rate for WIC participants was essentially unchanged at 65.5% (preimplementation) and 65.1% (postimplementation). Overall rates of breastfeeding initiation appeared quite stable even as WIC package assignments changed.

Ironically, the program cost more AND made full formula feeding more economically rewarding than partial breastfeeding :

Before implementation, the estimated average market value was $668 for the full breastfeeding package, $1669 for the partial breastfeeding package, and $1380 for the full formula package; hence, the partial breastfeeding package had the highest value. After implementation, the estimated average market value was $1028 for the full breastfeeding package, $1130 for the partial breastfeeding package, and $1345 for the full formula package; hence, the full formula package had the highest value.

I’m glad that the data demonstrates incontrovertibly that the program is completely ineffective, but I could have told them that before they implemented it. It is hardly surprising that it doesn’t work since it was predicated on assumptions that have no basis in fact. The fundamental erroneous assumption, beloved of lactivists, is that the decision to bottle feed is the result of ignorance and cultural pressure.

Lactivists prefer fantasizing about why women bottle feed instead of acknowledging the real reasons. Breastfeeding is hard, often painful (particularly during initiation) and inconvenient.

Faced with the complete failure of the program, it finally occurs to the authors that there was always a very real chance that the program would not work:

An objective of the policy changes was to encourage adoption of the full breastfeeding package and to promote breastfeeding. However, the changes in package options could, in principle, have multiple effects. First, even if infant feeding choices are predetermined or fixed, the policy change could have a reclassification effect that leads fewer cases to be assigned partial breastfeeding status and more cases to be assigned full formula status, without greatly influencing actual breastfeeding behaviors in either direction. A mother who relies principally on infant formula, supplemented by breastfeeding, could have been classified as partial breastfeeding before implementation and full formula after implementation. In this case, there would have been a change in package assignments without large effects on
breastfeeding outcomes…

In other words, the new program simply forced women to commit to full bottle feeding or full breastfeeding and reduced the number of women trying to do both.

Unfortunately, the authors appeared to have learned nothing from their own study. They are still clinging to the cherished lactivist fantasy that they can manipulate women into higher breastfeeding rates through greater “rewards” and more “education”:

A first option is to investigate an additional increase in the economic value of the full breastfeeding and partial breastfeeding packages relative to the full formula package…

A second option is to assess additional improvements in staff training and efforts of breastfeeding promotion … Besides educating mothers about the package changes, an expansion of breastfeeding education programs may offer another approach to breastfeeding promotion. Such programs cover the benefits of exclusive breastfeeding, especially during the first month postpartum.

So let’s see if I get this straight:

The WIC program designed to increase breastfeeding rates by “rewarding” and “educating” women was a complete failure, but the authors think that the next step should be to try higher rewards and more education?

What evidence is there that those steps would work? No evidence, of course, but lactivists would rather cling to their fantasy reasons for not breastfeeding rather than investigate the real ones.

Here’s a thought:

Stop assuming that women in the WIC program are like dogs who can be trained to perform tricks and rewarded with treats.

They are people. Treat them like people! If you want to know why women don’t breastfeed, ASK THEM!

You aren’t going to like the answer, but at least you’ll stop wasting taxpayer dollars on failing programs that rely on demeaning assumptions.

Has Mayor Bloomberg lost his mind?

Mayor Bloomberg is pushing hospitals to hide their baby formula behind locked doors so more new mothers will breast-feed.

Starting Sept. 3, the city will keep tabs on the number of bottles that participating hospitals stock and use — the most restrictive pro-breast-milk program in the nation.

How on earth could he imagine that treating infant formula like prescription medication is a remotely defensible use of government power? Perhaps he’s been spending too much time in lactivist-land, that fantastical alternate world where breastfeeding is easy, cost free and only undermined by imaginary social and cultural pressures.

If so, he’s not alone. All too many, Western, white women, relatively well off women have elevated their personal preferences into a standard to which all other women should aspire. And if they don’t aspire to emulate Western, white women? They should be regulated and punished into doing so, of course.

The dirty little secret about the latest efforts to promote breastfeeding (prohibiting formula gift bags, denying bottle feeding WIC mothers the same benefits as breastfeeding mothers, hiding formula in hospitals) is that they are purposely punitive, vindictive and serve only to bolster the self image of those implementing them. I suspect if lactivists thought they could get away with it, they’d propose branding bottlefeeding mothers with a scarlet “B”.

I’m not the first person to have noted the self-serving, moralizing that undergirds current attempts to promote breastfeeding. As Amy Romagnoli and Glenda Wall write in a new paper, ‘I know I’m a good mom’: Young, low-income mothers’ experiences with risk perception, intensive parenting ideology and parenting education programmes:

… Teen/young mothers and their children are generally accepted by professionals and society as an ‘at risk’ social group in need of surveillance and intervention. Macvarish (2010) outlines how the ‘discourse of risk’ has replaced the former overt moralisation of the ‘unwed mother’, yet functions to maintain society’s view of teen motherhood as a social threat by casting the young mother as lacking necessary rationality to manage risk. The resulting ‘social problem’ of teen motherhood is a construction based on white middle-class ideals and rooted in politically and historically specific understandings of female sexuality, education and occupational attainment…

… [T]he assumption made … is that older mothers always bond with, stay at home with, and feel no ambivalence about their children. This in turn serves to legitimate intervention on the mothering practices of the young, and parenting classes are often seen as an essential component of such intervention

The latest efforts to regulate infant feeding aren’t merely restricted to punishing the behavior of young, unmarried women. Contemporary lactivists want to punish anyone who doesn’t emulate them. It would be more accurate to state:

The ‘social problem’ of bottle feeding is a construction based on white middle-class ideals and rooted in politically and historically specific understandings of female sexuality, education and occupational attainment…

The assumption made is that Western, white, relatively well off good mothers always bond with, stay at home with, and feel no ambivalence about their children. Therefore, it is legitimate to regulate the mothering practices of anyone who does not emulate them.

These attempts at regulating infant feeding choices are wrong and a blatant misuse of government power. The benefits of breastfeeding are too small, the costs of breastfeeding are too high, and the utter lack of evidence that such efforts are effective combine to reveal these practices for what they really are: the contemporary effort of “good” mothers to shame and punish those who are “bad” mothers, “bad” only because they don’t copy their “betters.”

Natural childbirth advocates are neo-Luddites.

The original Luddites appeared during the Industrial Revolution and were weavers who were replaced by mechanized weaving, which produced high quality cloth faster and for less money, not incidentally depriving them of the job and lifestyle they desired.

I was reminded of the Luddites when I read the Science and Sensibility post on the consensus statement produced by three midwifery organizations, Supporting Healthy and Normal Physiologic Childbirth; A Consensus Statement by ACNM, MANA and NACPM. It’s the classic manifesto of a neo-Luddite movement, protesting technology because it threatens their jobs and their way of life.

Who are neo-Luddites? According to Wikipedia:

Neo-Luddism conjures pre-technological life as the best post-technological prospect … or as Robin and Webster put it, “a return to nature and what are imagined as more natural communities” …

Neo-Luddism expresses significant doubts about the nature of benefits from uncritically embracing new …technology. Neo-Luddism holds the belief that we were better off before its advent …

Neo-Luddites are:

… a diverse group that includes writers, academics, students, families, Amish, Mennonites, Quakers, environmentalists, “fallen-away yuppies,” “ageing flower children” and “young idealists seeking a technology-free environment”…

Moreover:

Neo-Luddites use technologies despite viewing them as the enemy. Some even use e-mail, … [and] the World Wide Web to to disseminate neo-Luddite propaganda… Sale describes neo-Luddites’ use of technologies as “a contradiction and a compromise, however, that sits easily with no one and is justified only in the name of the urgency of the cause and the need to spread its message as wide as possible”.

Sound familiar?

Supporting Healthy and Normal Physiologic Childbirth; A Consensus Statement by ACNM, MANA and NACPM is a classic neo-Luddite cri de coeur:

A normal physiologic labor and birth is one that is powered by the innate human capacity of the woman and fetus. This birth is more likely to be safe and healthy because there is no unnecessary intervention that disrupts normal physiologic processes . Some women and/or fetuses will develop complications that warrant medical attention to assure safe and healthy outcomes. However, supporting the normal physiologic processes of labor and birth, even in the presence of such complications, has the potential to enhance best outcomes for the mother and infant.

Let me perform the English to English translation to make the Luddism clear:

A normal physiologic labor and birth is one that is powered by the innate human capacity of the woman and fetus attended by midwives.

This birth is more likely to be safe and healthy good for midwives because there is no unnecessary intervention that disrupts normal physiologic processes intervention that cannot be provided by midwives without the assistance of a doctor.

Some inferior women and/or fetuses will develop complications that warrant medical attention to assure safe and healthy outcomes.

However, supporting the normal physiologic processes of labor and birth, even in the presence of such complications, has the potential to enhance best outcomes for the mother and infant midwife income.

Ahh, that’s better, because that’s what this is really about.

The original Luddites protested the introduction of technology because they did not know how to use it, so it replaced them and threatened their way of life. That the new technology produced higher quality cloth quickly and cheaply, and therefore benefited everyone was irrelevant to them. Not surprisingly (since their incomes were on the line), they valued process above outcome.

Similarly, birth luddites protest the introduction of technology into childbirth because they are not capable of using it, so obstetricians (who do know how to use technology) replace them and their way of life is threatened. That the new technology produces better outcomes for mothers and babies and therefore benefits everyone is irrelevant to them. Not surprisingly (since their incomes are on the line), they value process above outcome.

The original Luddites lost, of course. People bought the cloth woven on machines because they valued the outcome: less expensive, more accessible cloth. Although they don’t realize it, birth luddites have already lost the battle and the war. Women value the outcome of interventions in childbirth: less pain, dramatically fewer neonatal deaths and dramatically fewer maternal deaths.

Birth luddites should learn from the experience of the weavers. You can’t stop technology when it improves outcomes.

I have a great idea.

It’s well known that poor children often have poor diets. Food stamps* can be used to buy any type of food; poor mothers often buy processed foods that are cheap and easy to prepare instead of fresh vegetables and fruits that are more nutritious. Here’s my idea: let’s take away food stamps and force poor women to grow their own food. They can set up small plots at community gardens and grow healthful fruits and vegetables. Maybe they can even get a few chickens so their children can have fresh eggs daily and roast chicken for special occasions.

Wait, what? You think that is punitive, vindictive and more likely to result in starving children than in children getting their daily supply of vitamins and minerals? But how can that be? I’m simply copying the WIC policy designed to encourage breastfeeding.

Yes that’s right. WIC has insituted policies that will supposedly discourage formula feeding.

I’ve written before that delayed cord clamping has been found to have no clinical benefits in term infants, but there has been some evidence that it is beneficial for premature babies because it reduces the need for blood transfusions in babies who are likely to develop anemial of prematurity. The latest paper on the topic puts even that claim in doubt.

Delayed Umbilical Cord Clamping in Premature Neonates will appear in the August issue of Obstetrics and Gynecology. The authors explain:

This was a before–after investigation com- paring early umbilical cord clamping with delayed um- bilical cord clamping (45 seconds) in two groups of singleton neonates, very low birth weight (VLBW) (401– 1,500 g) and low birth weight (LBW) (greater than 1,500 g but less than 35 weeks gestation). Neonates were excluded from delayed umbilical cord clamping if they needed immediate major resuscitation. Primary out- comes were provision of delivery room resuscitation, hematocrit, red cell transfusions, and the principle Vermont Oxford Network outcomes.

What did they find?

All neonates had a hematocrit determination (largely peripheral venous) 30 – 60 minutes after birth… VLBW and LBW neonates who underwent delayed umbilical cord clamping had a significantly higher hematocrit, but delayed umbilical cord clamping did not significantly lower the overall NICU red blood cell transfusion rate. Delayed cord clamping was associated with higher mean systolic and diastolic blood pressures in neonates with LBW. Highest measured total bilirubin concentration and use of phototherapy were not significantly different between the early umbilical cord clamping and delayed umbilical cord clamping groups… [W]e observed no significant differences in any of the principle Vermont Oxford Network VLBW morbidities, mor- tality, growth rates, or length of stay …

Delayed cord clamping made no difference in the incidence of chronic lung disease, retinopathy of prematurity, intraventricular hemorrhage, necrotizing enterocolitis, infection, weight gain or length of stay. Obviously, the intitial hematocrit was higher in infants who underwent delayed cord clamping, but it resulted in no appreciable benefits.

The authors do point to one benefit, but fail to realize that it is a direct result of study design, not delayed cord clamping.

… [T]he overall provision of any delivery room resuscitation intervention was signifi- cantly less in the VLBW delayed umbilical cord clamping group (61% compared with 79%, P=.01) but not different between the LBW groups (30% compared with 27%, P=.55). Delayed umbilical cord clamping was associated with higher Apgar scores at 1 minute in VLBW neonates but no significant differ- ences in neonates with LBW….

That was only to be expected because:

… eligible neonates born in the second era did not have delayed umbilical cord clamping because the health care providers felt the neonate needed immediate major resuscitation. These six neonates had a mean postmenstrual age of 31 0/7 weeks, mean birth weight 1,618 g, Apgar score at 1 minute ranged from 0 to 5, Apgar score at 5 minutes ranged from 2 to 7, and all survived…

In other words, infants with the greatest need for resusciation were autonomatically excluded from the deleyed cord clamping group, but not the early cord clamping group. It’s hardly surprising then, that the delayed cord clamping group had fewer infants in need of resuscitation.

The authors conclude:

Delayed umbilical cord clamping can safely be performed in singleton premature neonates and is associated with a higher hematocrit, less delivery room resuscitation, and no significant changes in neonatal morbidities.

Even that tepid endorsement overstates the case. Obviously the hematocrit was initially higher in the delayed cord clamping group; delayed cord clamping inevitably increases the hematocrit initially. Obviously there was less need for resuscitation in the delayed cord clamping group since the infants with the greatest need for resuscitation had been removed from the group.

The bottom line is that delayed cord clamping provided no benefit of any kind.

During the past week I learned of three separate homebirth deaths:

1. Coos County Oregon District Attorney has indicted lay midwife Marcene Rebeck for second-degree manslaughter and criminally negligent homicide in the death of a baby she delivered last year. According to the local newpaper:

The infant who died was a daughter born about a year ago to Bethany Reed of Riverton, who runs Abba Farms with her mother Linda Cummins. The infant died after a long labor and home birth when it was a few days old. The cause of death was listed as septis [sic], an illness in which the body has a severe response to bacteria or other germs.Rebeck, who also owns the Espresso Factory in Bandon, runs a local Montessori-based school and teaches Jazzercise classes, said she has delivered 300 babies during her career, with only one death and no other major incidents.

So now she’s had 2 deaths in only 300 babies for a whopping death rate of 6.6 deaths/1000, more than 15 times higher than the death rate for comparable risk women in the hospital.