MyMilk Labs launches Mylee, a small sensor that analyzes breast milk at home is the title of a recent piece on TechCrunch:

Parents often worry about if their babies are getting enough nutrition or if they are producing enough milk. MyMilk Labs wants to give nursing mothers more information with Mylee, a sensor that scans a few drops of breast milk to get information about its composition and connects to a mobile app…

The Mylee launched at Disrupt with a pre-order price of $249 (its regular retail price is $349). Based in Israel, MyMilk Labs was founded in 2014 by Ravid Schecter and Sharon Haramati, who met while working on PhDs in neuroimmunology and neurobiology, respectively, at the Weizmann Institute of Science…

Breast milk changes in the first days and weeks after birth, progressing from colostrum to mature milk. Mylee scans the electrochemical properties of milk and then correlates that to data points based on MyMilk Labs’ research to calculate where the sample is on the continuum, then tells mothers if their milk is “delayed” or “advanced,” relative to the time that has passed since they gave birth.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It could work, but we need much more data to know if it does work.[/pullquote]

Does it work? Should anyone use it? The short answers: it could work; we need to see data about its sensitivity and specificity; and lactation professionals have philosophical objections to it.

It could work

I can’t find much technical information about the device, but the theory behind it is sound. Lactogenesis II is the process responsible for the progression of breast milk production from colostrum, through transitional milk to mature milk. There is a biomarker that can be used to track progress through the progression.

The Relation between Breast Milk Sodium to Potassium Ratio and Maternal Report of a Milk Supply Concern (2017) explains:

The ratio of breast milk sodium to potassium concentrations (breast milk Na:K) dramatically declines … as lactation progresses through colostral, transitional, and mature milk production stages; thus, decreasing breast milk Na:K is an objective biomarker of mammary gland progress toward copious mature milk production over the first week postpartum.

When they compared the breastmilk of women reporting low supply to that of women with adequate supply they found:

…[E]levated day 7 breast milk Na:K occurred in 42% of mothers with a day 7 milk supply concern, compared with 21% of mothers without a day 7 milk supply concern (unadjusted relative risk, 2.0; P = .008) (Table II). The unadjusted odds of elevated Na:K were 2.7 greater (95% CI, 1.3-5.9) with maternal report of milk supply concern (reference = no concern, P = .01) and further increased after adjustment for maternal ethnicity (3.4; 95% CI, 1.5-7.9; P = .003).

In other words, in contrast to lactivist beliefs, women who reported low supply did not “misperceive” the situation. Their breastmilk had an elevated ratio of sodium (Na) to potassium (K).

If concerns about milk supply among exclusively breastfeeding women were primarily owing to a lack of knowledge about the signs of abundant milk production, then the expected outcome would be no difference in breast milk Na:K as compared with exclusively breastfeeding women without milk supply concerns… Instead, the observed prevalence of elevated Na:K was 2-fold greater in the mothers with milk supply concerns (42% vs 21%)… This result challenges the belief that milk supply concern in the context of exclusive breastfeeding is primarily maternal misperception…

If the Mylee device analyzes the Na/K ratio and compares it to the expected ratio based on time since birth, the device could diagnose insufficient milk supply.

Does it actually work?

There’s no way to know without analyzing data from large numbers of women. Even if the device can successfully predict low milk supply, we’d need to determine its accuracy. What’s the false positive rate (indicating low supply even though supply is adequate)? What’s the false negative rate (indicating adequate supply even though supply is low)? Without that information — from a peer reviewed scientific paper — it is impossible to know if the Mylee device does what it claims.

If it works, should we use it?

Not surprisingly, lactation professionals appear to be reflexively opposed to its use. Its mere existence poses a serious challenge to the cherished lactivist beliefs that insufficient breastmilk is rare, that women who report it are “misperceiving” the size of their supply, and that “trusting” their bodies is the key to successful breastfeeding.

But if it turns out that the Mylee analyzer has a high rate of accuracy, they may quickly change their assessment. Why? Because it could be a huge revenue source for lactation consultants.

The device is slated to cost $349, well beyond the means of most women. Lactation consultants could purchase the device and charge a fee for testing a client. If they charged just $25 per analysis, they could earn back the cost of the device after only 14 tests; thereafter, the $25 per test would be pure profit.

Being able to do the analysis would almost certainly improve the popularity of the lactation consultant relative to her peers. Moreover, in the situation where the test indicated a normal Na/K ratio, lactation consultants could reassure patients with objective evidence that their supply was adequate and that they actually should trust their bodies. In contrast, if the test indicated a high Na/K ratio, women could be assured that low supply was biological, not lack of effort on their part. It is possible that such testing could help determine the efficacy in increasing supply of pumping regimens and galactologue supplements and medications.

Should anyone buy the device?

Even though the theory behind it is sound, I’d need to see much more scientific evidence of efficacy before I would recommend it for anyone. An accurate test could be very beneficial. An inaccurate test would be worse than useless.

Honestly, are there any bigger hypocrites than natural mothering advocates?

Their philosophy is based on the belief that childbirth and breastfeeding evolved to be perfect. They tell themselves and each other that women are perfectly “designed” (or evolved, if you prefer) to give birth vaginally without pain medication and therefore that must be best. Women are perfectly “designed” (or evolved, if you prefer) to breastfeed exclusively and for years at a time, so that must also be best. In nature, women co-slept with their babies, so — regardless of the demonstrated increased risk of death to babies — co-sleeping must be best. After all, anything that promotes breastfeeding is, by their definition, best for babies even if it kills them.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Why aren’t women who advocate slavish devotion to what “nature intended” for childbirth and breastfeeding equally insistent on early and frequent pregnancies?[/pullquote]

But fertility and child spacing were also “designed” by nature (or evolution, if you prefer). Here’s what natural fertility and child spacing looked like:

• Menarche was age 16 or so
• Childbearing began in the late teens
• Women could not control fertility
• The average woman experienced 8-10 pregnancies
• Life expectancy was 35 years

So why aren’t women who advocate slavish devotion to what “nature intended” for childbirth, breastfeeding and co-sleeping equally insistent on early and frequent pregnancies?

Shouldn’t every woman become sexually active within a year or so of menarche?

When sexually active, shouldn’t every woman eschew fertility control of any kind?

Shouldn’t childbearing start in the late teens?

Shouldn’t women be perpetually pregnant or nursing, only rarely having menstrual periods?

Shouldn’t every woman have 8-10 pregnancies or more?

Wait, what? That’s not convenient/desirable/compatible with contemporary lifestyles?

So? If convenience/desire/compatibility with contemporary lifestyle aren’t justifications for epidurals, formula feeding and infants sleeping in cribs, how can they be justifications for women to control fertility, delay childbearing and limit the number of children they have?

Isn’t there something fundamentally unnatural about any women who delays childbirth until her late twenties or even late thirties?

If it’s “selfish” to have an epidural or formula feed, isn’t it equally selfish to delay childbirth until you’ve found your soulmate?

Delaying childbearing for a career? There were no careers in nature.

Early and frequent pregnancies are harmful to women’s health? How could that be if women are “perfectly designed” to have early and frequent pregnancies?

Tell us, natural mothering advocates, if women are supposed to “trust” birth and breastfeeding, why shouldn’t they trust unhindered fertility and frequent childbearing?

Inquiring minds want to know!

It’s the central obsession at the heart of contemporary breastfeeding promotion, and it serves as a justification for the shaming tactics so beloved of lactivists.

It’s the fantasy that the formula industry is waging war on breastfeeding.

[pullquote align=”right” cite=”” link=””]Formula was not created as a substitute for breastfeeding; it was created to replace the raw animal milk women were already using as a substitute for breastfeeding.[/pullquote]

Don’t get me wrong; the formula industry is trying to make money. And, yes, decades ago they engaged in deceptive practices to convince women in developing countries to formula feed; but there was never a similar campaign in industrialized countries for a very simple reason — women couldn’t or wouldn’t breastfeed long before formula even existed.

Formula was not created as a substitute for breastfeeding; it was created to replace the raw animal milk women were already using as a substitute for breastfeeding.

As Jacqueline Wolf explains in the chapter Saving Babies and Mothers: Pioneering Efforts to Decrease Infant and Maternal Mortality, in the book Silent Victories: The History and Practice of Public Health in Twentieth Century:

The custom of feeding cows’ milk via rags, bottles, cans and jars to babies rather than putting them to the breast became increasingly common in the last quarter of the nineteenth century progressed… In 1912, disconcerted physicians complained bitterly that the breastfeeding duration rate had declined steadily since the mid-nineteenth century “and now it is largely a question as to whether the mother will nurse her baby at all. A 1912 survey in Chicago … corroborated the allegation. Sixty-one percent of those women fed their infants at least some cows’ milk within weeks of giving birth.

And the results were deadly:

The late nineteenth century urban milk supply killed tens of thousands of infants each year. Unpasteurized and unrefrigerated as it journeyed from rural dairy farmer to urban consumer for up to 72 hours. cows’ milk was commonly spoiled and bacteria-laden. Public health officials dramatically charged that in most U.S. cities, milk contained more bacteria than raw sewage …

Those death rates did not start falling until cows’ milk was replaced by infant formula, which more closely matches the composition of human milk, is uncontaminated and is very convenient to buy, store and use.

Breastfeeding, like most natural processes, has a high natural failure rate. Up to 15% of new mothers don’t make enough milk to fully nourish a growing baby, especially in the first few days after birth. In addition, breastfeeding can be difficult, painful, frustrating and incompatible with women’s work outside the home.

Infant formula finally made the widespread use of breastmilk supplements safe. It’s no different from birth control. The manufacturers of the Pill didn’t need to convince women to use birth control; they simply made birth control safe and effective.

The similarities don’t end there.

Why do formula manufacturers advertise? For the same reason that birth control manufacturers advertise: to claim market share.

Manufacturers of various formulations of The Pill, condoms and diaphragms aren’t engaged in a war on children. Women themselves WANT to regulate their fertility. They don’t want to subject themselves to a dozen pregnancies across a reproductive life and they don’t want to raise a dozen children. No one needs to convince women to prevent pregnancy; the market for birth control encompasses just about every woman of reproductive age in every country. The issue for women is not IF they are going to use birth control, but WHICH form of birth control they are going to use. That’s why purveyors of birth control advertise.

Formula manufacturers advertise for the same reason. The issue is not IF women are going to use formula; many will choose to do so regardless. The issue is which brand to use. It’s the same reason why formula companies give free samples of their product. Contrary to the lactivist fantasy that formula samples are aimed at seducing women away from breastfeeding, the industry is not worried about IF women will use formula; it’s concerned about WHICH formula brand they are going to use.

Lactivists have used the fantasy of formula manufacturers warring against breastfeeding to justify their tactics of grossly exaggerating the benefits of breastfeeding, pretending there are “risks” to formula feeding, invoking shaming language to pressure women into breastfeeding, and employing Orwellian programs like the “Baby Friendly Hospital Inititiative” to force new mothers to breastfeed. They believe they are waging war against the formula industry; the reality is that they waging war against women’s bodily autonomy.

Women use formula for the same reason that women use birth control; it allows them to determine when and how they use their reproductive organs. Lactivists oppose formula for the same reason that religious fundamentalists oppose birth control. Fundamentalists believe no woman should have sex unless there is a chance for pregnancy; lactivists believe no woman should give birth unless she plans to breastfeed.

In both cases, what is at stake is not the financial health of corporations, but the rights of women.

The Fed Is Best movement has completely changed the conversation around breastfeeding.

True, they haven’t yet gotten lactation and health organizations to acknowledge outright that the benefits of breastfeeding term babies in industrialized countries are so trivial that they literally cannot be measured. But we (I consider myself part of the movement though I’m not part of the Foundation) have forced a re-framing of the conversation. And as I’ve written many times in the past, when you frame the discussion, you own it.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breastfeeding matters to approximately 1% of babies in industrialized countries. There is no evidence that it has a substantive impact on 99%.[/pullquote]

A new piece from microbiome researcher Meghan Azad, PhD, offers an excellent example. In explaining why breastfeeding matters to everyone, Dr. Azad unwittingly shows why it doesn’t much matter.

The author begins with the fallback position into which breastfeeding researchers have been forced: the language of breastfeeding “goals.”

Research in the US has found that most women (60%) do not meet their own breastfeeding duration goals…

This reflects the lactivist understanding that intense pressure to breastfeed, such as the Baby Friendly Hospital Initiative, will no longer be tolerated going forward. That doesn’t mean that lactation professionals recognized the error of their anti-feminist ways, merely that they’ve modified their language.

“Look at us,” they invite. “We’re not pressuring women to breastfeed; we’re helping them meet their goals!”

That’s about as persuasive as the fashion industry absolving itself of the pressure on women to be thin by declaring, “We not pressuring women to lose weight; we’re helping them meet their weight goals!”

Dr. Azad then asks:

But is breastmilk truly better than formula milk for supporting infant health outcomes?

She answers yes, but puts so many qualifiers around it that she’s basically acknowledging that no, it doesn’t matter.

… [T]he magnitude of difference depends on a multitude of factors including genetics, the environment, socio-economic factors, medications, length of gestation (prematurity), and method of birth. Simply put, a healthy full-term infant born vaginally with no genetic risk factors may not benefit to the same extent from breastfeeding as a premature infant requiring multiple medications and interventions …

This is just another way of admitting to what I have been writing for more than a decade: in industrialized countries breastmilk can have lifesaving benefits for extremely premature infants (only 1% of infants born each year) but has negligible benefits for term babies.

When it comes to the rest of the world, Dr. Azad persists in promoting the fantasy that breastfeeding could save more than 800,000 lives per year. She fails to note that this is based on a mathematical model that has never been validated and the model itself erroneously assumes causation for every observed correlation. She also neglects to mention that the countries with the highest breastfeeding rates (98%+) have the highest infant mortality rates. If the babies who are already being breastfed are the ones who are dying, how could increasing breastfeeding rates elsewhere save them?

Then Dr. Azad pivots to tenuous “benefits” that have never been confirmed. As I recently explained, the ever more nebulous benefits of breastfeeding (the microbiome! epigenetics!) are a fallback position, an acknowledgment that the substantive benefits of breastfeeding have been largely debunked.

Breastmilk also contains many factors that directly enhance the infant’s immune system, regulate appetite and support their gut bacteria. For example, there are special sugars in breastmilk called human milk oligosaccharides (HMOs). HMOs are the third most abundant solid component in breastmilk, yet they are completely indigestible to the infant. The primary role of HMOs is to act as a prebiotic, or food source, for beneficial bacteria in the infant’s gut, such as Bifidobacterium longum subspecies infantis (B. infantis). This bacterium is specifically adapted to proliferate in the presence of HMOs, allowing it to prevent the growth of other potentially pathogenic bacteria by crowding them out.

And:

B. infantis and other gut bacteria (collectively known as the ‘gut microbiome’) also help train the infant immune system and produce essential vitamins, having a long-term impact on infant health and development. While there is still much to learn about what constitutes a healthy or unhealthy microbiome, we know that breastfeeding is among the most influential factors shaping this important community of ‘good bacteria’.

How does that affect the health of individual infants? To date, there is no evidence that it does.

Dr. Azad continues with ever smaller benefits:

Breastfeeding is also protective against breast cancer, offering a 4.3% reduction in risk for every 12 months that a mother breastfeeds over the course of her lifetime …

But pregnancy raises the risk of breast cancer by 16% over the following years. Yet the researchers who made that discovery claim that risk is so small that it shouldn’t be factored into the decision to have children. If that’s the case, why should a much smaller reduction in the risk of breast cancer from breastfeeding factor into the decision on how to feed infants? It shouldn’t.

But wait! Breastfeeding is important for the environment!

It is important to consider the environmental savings of breastfeeding as opposed to the environmental footprint created by formula feeding. It is estimated that more than 4000 L of water are required to produce 1 kg of powdered formula and that 86 000 tonnes of metal and 364 000 tonnes of paper end up in USA landfills annually as a result of formula packaging…

This is taken directly from the new nonsensical editorial in the BMJ that I wrote about only last week (Climate change: have you tried squirting breastmilk on it?).

The calories in breastmilk come from the increased amount of food that breastfeeding women must eat. In contrast to cows who need only consume grass to make milk, women need meat (produced by industrial farming), vegetables and fruit (produced by industrial agriculture) and fish (caught by practices that are destroying the oceans).

Moreover, how green is the plastic used in breast pumps? How green is the electricity and batteries used to power them? How green are nursing bras made with synthetic fibers? How green are special clothing, breastfeeding pillows and other breastfeeding accessories?

Dr. Azad concludes:

A cost analysis of common childhood infectious diseases that can be prevented through breastfeeding (gastroenteritis, necrotizing enterocolitis, respiratory tract infections, and acute otitis media) found that a 10% increase in exclusive breastfeeding until 6 months and sustained breastfeeding until 1 year could save the US healthcare system $312 million per year.

That sounds impressive until you consider that breastfeeding itself has become the leading risk factor for newborn hospitalization. An astounding 1 in every 71 exclusively breastfed babies will be hospitalized leading to approximately 40,000 preventable hospital admissions per year at a cost of hundreds of millions of dollars. That doesn’t even include the downstream costs of neonatal brain injuries from dehydration and severe jaundice.

The bottom line is that breastfeeding matters only to approximately 1% of babies in industrialized countries. There is no evidence — and Dr. Azad fails to provide any evidence — that it has a substantive impact on the other 99%.

Lactation professionals are losing ground to the Fed Is Best movement. In their frustration they are preparing to lash out, taking a page out of the Donald Trump playbook.

How is the lactation leadership like Trump?

Let me count the ways!

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]They are thin-skinned, lack self-reflection, are monumentally aggrieved, project criticism, abuse the regulatory system and are exposed by whistleblowers.[/pullquote]

1. They are incredibly thin-skinned.

Ever notice how lactation professionals — the same folks who have institutionalized shaming mothers through the “Baby Friendly” Hospital Initiative — are incredibly sensitive? They can’t take the kind of criticism that they routinely dish out to others.

They insinuate or even claim that women who can’t or don’t wish to breastfeed are lazy, self-absorbed and don’t love their children enough to do what’s “best.” They accuse health professionals who disagree with them of taking industry money even though they have no evidence of any kind. They create memes to demonize formula and humiliate the women who use it.

But if you criticize them they, like Trump, collapse into self-pity. They seem to think they are perfect and insist that those who criticize them are haters.

2. They lack the capacity for self-reflection.

Breastfeeding has become the leading risk factor for newborn hospital readmission, leading to tens of thousands of unnecessary hospitalizations per year at a cost of hundreds of millions of dollars. This is a massive healthcare scandal and no lactivist organization denies this is happening. Shockingly, they are making no effort to do anything about it.

They won’t even engage in self-reflection. They don’t ask themselves what they are doing wrong, because, like Trump, they believe that they are incapable of doing wrong. Individual women are crying out to them to stop the pressure, yet they continue to ramp it up with gratuitously cruel tactics like formula “consent forms” and advocating that formula be available by prescription only.

3. A monumental sense of grievance.

When you cannot accept that you might be wrong, any criticism is perceived as persecution. Like Trump, they are always sure they are being treated “unfairly” by their “enemies.”

Someone sent me this to warn me about the impending attack:

Is there anyone who has been targeted or harassed by Fed Is Best and has not contacted us yet. Please do so ASAP.

Real medical professionals (like real presidents) don’t view every criticism as harassment.

4. Projection of criticism.

I recently read an Op-Ed that claimed that everything out of Trump’s mouth is either projection or a lie. When lactation professionals discuss the Fed Is Best movement, nearly everything that comes out of their mouths is either projection or a lie.

They accuse feeding safety advocates of harming babies and mothers (without any evidence) when it is they who are responsible for the tens of thousands of unnecessary newborn hospitalizations and the soul searing guilt of new mothers. They accuse Fed Is Best and myself of profiting from advocating for safe infant feeding (a bald-faced lie) when it is they who are profiting from promoting UNSAFE infant feeding.

5. Abuse of the regulatory system.

Trump is a master of this, repeatedly attempting to subvert various government agencies to punish his enemies.

Lactation professionals are privately advocating for “reporting” various feeding safety advocates to their licensing boards. The recent treatment of Midwife Cath for daring to write the truth is a case in point.

The thing with lactation is we ALL can lactate but we ALL don’t lactate the same amount… don’t feel bad if you can’t squirt this much milk”.

The Instagram post continues, “Rather than babies going hungry or sitting on a pumping machine … remember that #fedisbest”.

Lactivist midwives subverted a regulatory agency to punish a woman who deviated from the party line.

6. Whistleblowers

There are many lactation professionals who are alarmed by the growing number of babies and mothers harmed by lactivist orthodoxy. They provide me and others with a steady stream of private social media messages that highlight the contempt in which lactation professionals hold women who can’t or don’t wish to breastfeeding, the stunning lack of self-reflection, the sense of grievance and the efforts to punish enemies.

I don’t know exactly what lactation professionals have planned for their forthcoming campaign but when it arrives I suggest you compare the attack to the types of attacks orchestrated by Trump.

Ask yourself:

Are the lactation professionals involved incredibly thin-skinned?
Have they avoided self-reflection?
Do they demonstrate a monumental sense of grievance?
Are they projecting?
Are they trying to abuse the regulatory system?
Were their actions revealed by whistleblowers?

In short, don’t let lactation professionals fool you with a page from the Trump playbook.

They give their members a meaningful account of why the world is the way it is. They provide them with a sense of purpose and the possibility of sainthood. They offer a sense of community. And they establish clear roles and rituals that allow adherents to feel and act as part of a whole. These aren’t just subcultures; they are churches.

These words were not written about lactivist beliefs, but they apply to them.

The author was writing about the quasi-religious hunger of white supremacists:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]We were expelled from the Breastfeeding Garden of Eden because we ate from the Tree of Formula Knowledge.[/pullquote]

…[T]hese groups promise their members a sense of purpose within [a] chaotic world: a chance to participate in a cleansing fire. They are called to take up the mantle of warriors for the cause …  as someone with a vital role to play in a cosmic war.

But the social and communal appeal of these groups is nearly as important to understand as their ideological, world-shaping ones. Like nearly all religious groups, they use shared languages and shared rituals…

Perhaps most important, these groups give their adherents, many of whom perceive themselves as socially isolated, a sense of community…

Lactivists also have a quasi-religious hunger for meaning, purpose and shared struggle. They’ve created a metaphorical “Church of the Immaculate Colostrum” and a theology to justify it.

1. The Garden of Eden

Every religion has a creation myth and lactivism is no different. Nature supposedly designed breastfeeding to be innately perfect and we used to live in a breastfeeding Garden of Eden where mothers always breastfed exclusively and for many years.

So what happened?

2. The Fall

Women fell from the grace of exclusive, extended breastfeeding. The serpent in the Garden was — I bet you guessed it – formula. Evilly seductive formula lured women farther and farther from the perfection of breastfeeding. As a result, people developed diseases like autism, cancer and obesity.

We got sick because we ate from the Tree of Formula Knowledge.

3. Demons

We are now plagued by demons. Of course we don’t call them demons. We call them chemicals. Formula is filled with them; they are insidious; and they exist for the sole purpose of harming babies.

4. Predestination

Just like the Calvinist belief in predestination allowed the spiritual elect to be identified by their wealth and success, lactivism has its own version of predestination. The spiritual elect can be identified by their exclusive, extended breastfeeding, by breastfeeding in public and by their condemnation of formula feeders.

It goes without saying that women who can’t breastfeed (or “claim” they can’t) have done something wrong, have not demonstrated the appropriate faith or have been led astray by the Devil.

5. The Devil

Formula companies are the devil. They are the original evil and the source of all subsequent evil. To hear lactivists tell it, no one used breastmilk substitutes until formula companies were created, and no one wanted to use breastmilk substitutes until formula companies hoodwinked them into doing so.

6. Sin

Sin is formula use. It doesn’t matter whether the formula is used to supplement a baby who is starving, used to allow a depressed mother to get healing sleep, or used because some fathers want to feed their babies, too. Formula use is always sinful.

6. Faith

Like all religions, lactivism requires faith.

Baby screaming for hours in hunger, losing weight and pediatrician recommending formula supplementation? Have faith in breastfeeding, Mama! No circumstances can you justify the sinful use of formula.

The most fervent lactivists are often women who struggled desperately to breastfeed while letting their babies starve. But an emaciated baby is a small price to pay in exchange for being lauded by the members of your Facebook breastfeeding group for your undiminished faith in breastfeeding.

7. Priests

Like any religion, lactivism has its own priests and priestesses: lactation professionals. Their existence is based on the premise that breastfeeding “died out” because of the Formula Company Devil; lactation professionals are merely bringing women back to “true religion.” Promoting breastfeeding instead of promoting infant health, lactation consultants offer support: tremendous pressure, exaggerated benefits, and scary “risks” of formula.

8. Salvation

The goal of lactivism, like the goal of many religions, is to be saved and welcomed into paradise. In lactivism, paradise is the imagined state of perfect health and bliss provided by exclusive, extended breastfeeding. In the meantime, Facebook breastfeeding groups provide fellowship, shared language and rituals, and the delicious sense of superiority that is such an ugly part of lactivism.

There’s just one problem, the foundational stories that lactivists tell themselves and each other are lies:

There was NEVER a Breastfeeding Garden of Eden. Breastfeeding — like all bodily processes — has a significant failure rate. Back when every woman breastfed every child exclusively and for extended periods (if they live that long), the infant and child mortality rate was astronomical. By some estimates, as many as 50% of children died before age 5.

Breastmilk substitutes existed for literally thousands of years before the advent of formula companies. The need and desire for formula was MET by formula companies, NOT created by it. Formula, in fact, was designed to save infant lives that were being lost because women were feeding their babies animal milk contaminated with harmful bacteria.

Autism, cancer and obesity are not punishments for the sin of using formula. They are diseases that are caused by or can only be recognized in affluence. The alternative is dead babies and a natural life expectancy of 35, not perfect health.

No matter. Lactivism provides its adherents a meaningful (though false) account of why the world is the way it is. It provides them with a sense of purpose and the possibility of motherly sainthood. It offers a sense of community. And it establishes clear roles and rituals that allow adherents to feel and act as part of a whole.

That’s not science; it’s religion.

Climate change is the greatest existential threat we face.

Lactivists are meeting it in the same way they meet every other situation. They recommend putting breastmilk on it.

That’s the premise behind the ludicrous editorial in the BMJ Support for breastfeeding is an environmental imperative by Prof. Natalie Shenker.

Shenker declares:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]How green is a breast pump?[/pullquote]

Formula milk contributes to environmental degradation and climate change

Conversations around the complex subject of infant feeding have invariably focused on health outcomes, but recent studies have highlighted the environmental cost of decades of disinvestment in services to support breastfeeding. Breastfeeding uses few resources and produces minimal or zero waste. The associated infant and maternal health outcomes produce healthier populations that use fewer healthcare resources.34 The production of unnecessary infant and toddler formulas exacerbates environmental damage and should be a matter of increasing global concern.

I wrote about Prof. Shenker just a few months ago.

A physician had asked other physicians on Twitter:

Drs of Twitter! If your child had developed a mild superficial fungal infection over the weekend, would you buy some Canesten 1% (available from a pharmacist without prescription) or would you feel you needed to take your child to a walk-in centre for a formal diagnosis & script?

Shenker replied with this tweet:

Hey, hope the little one is ok. Have you tried putting breastmilk on? Contains fungicide components (probably for just this sort of thing)

Now she’s suggesting treating the entire planet with breastmilk.

As Dr. Steve Novella has written on Science Based Medicine:

One common feature of pseudoscience is that proponents of a specific belief tend to exaggerate its scope and implications over time…

Dr. Shenker’s editorial is a classic example of how breastfeeding promotion has veered into pseudoscience.

Lactivists are losing ground and they know it.

Several decades after predicting that increased breastfeeding rates would lead to decreased infant mortality, severe morbidity and healthcare spending, it has become clear that it leads to none of those things. That’s hardly surprising since there was never any correlation (let alone causation) between breastfeeding rates and infant mortality. For example, the UK has the lowest breastfeeding rate in the world AND one of the lowest infant mortality rates.

To the extent that increased breastfeeding rates in term babies have caused ANY measurable change, it is only to make things WORSE. Exclusive breastfeeding is now the leading risk factor for newborn re-hospitalization in the US, leading to TENS OF THOUSANDS of readmissions per year at a cost of hundreds of millions of dollars.

But lactation professionals have built entire medical and academic careers on promoting breastfeeding. Therefore, as it has become clear that substantive benefits of breastfeeding don’t exist, they’ve been hawking ever more nebulous “benefits” in areas like the microbiome and epigenetics.

The recommendation to squirt breastmilk on climate change was inevitable.

Prof. Shenker presents her case the same way that lactation professionals always present their case: looking only at benefits, ignoring both costs and risks.

According Shenker:

The food industry, particularly dairy and meat production, contributes around 30% of global greenhouse gases. Most formulas are based on powdered cows’ milk. The average water footprint of whole cows’ milk is around 940 L/kg: one kilogram of milk gives about 200 g of milk powder, meaning the water footprint of milk powder alone is roughly 4700 L/kg.

That sounds impressive until you consider that breastmilk supplies the same calories per ounce as formula and those calories have to come from from the food consumed by the mother. In contrast to cows who need only consume grass to make milk, women need meat (produced by industrial farming), vegetables and fruit (produced by industrial agriculture) and fish (caught by practices that are destroying the oceans).

Dr. Shenker fails to even consider the environmental impact of those factors.

She writes:

A 2009 study showed that 550 million infant formula cans, comprising 86 000 tons of metal and 364 000 tons of paper are added to landfills every year; the formula industry has more than doubled since then.

But how green is the plastic used in breast pumps? How green is the electricity and batteries used to power them? How green are nursing bras made with synthetic fibers? How green are special clothing, breastfeeding pillows and other breastfeeding accessories. Dr. Shenker doesn’t know because she never looked.

Then she adds a truly bizarre coda:

The amount spent on marketing infant formula worldwide has been estimated at over £5bn (€5.6bn; $6bn) a year—£36 for every child born. Costs to the environment include paper use, postage, plastic waste, and transport costs at multiple stages in the production, marketing, and sale of breastmilk substitutes.

Marketing? How does the environmental impact of marketing formula differ from the environmental impact of marketing breastfeeding? Oh, right, it doesn’t; yet Prof. Shenker does not suggest we stop marketing breastfeeding.

Indeed Prof. Shenker deliberately leaves out a lot of things.

Here’s just one: What is the environmental impact of tens of thousands of newborn re-hospitalizations each year: the cost of neonatal incubators (made in large part of plastic), IV tubing, blood drawing needles, etc. etc, etc?

There may be an environmental case for promoting breastfeeding, but by refusing to consider the environmental impact of breastfeeding itself and the increased risk of hospitalization, Prof. Shenker hasn’t made it.

If that weren’t bad enough, she shifts responsibility for addressing climate change from corporations who have caused it to individual mothers:

This is a societal responsibility to which we can all contribute. A multitargeted approach is required, including investment in medical education so doctors can support and signpost mothers if difficulties arise, improved antenatal information and care enabling parents to develop feeding plans alongside birth plans, better access to screened donor milk from a regulated milk bank when supplementation is needed, and increased numbers of certified lactation consultants. Cultural change is long overdue to remove the myriad obstacles to breastfeeding faced by new mothers.

According to the Union of Concerned Scientists, climate change is largely driven by CO2 production from the burning of fossil fuels. The contribution of the formula industry, if it even makes a contribution, is trivial.

No matter. Prof. Shenker isn’t trying to reduce climate change, she’s trying to promote breastfeeding and — like those who promote pseudoscience — exaggerating the scope of its effects and its implications in order to do so.

“We’re still here!”

It’s a favorite declaration of those attempting to justify natural parenting practices:

Childbirth without interventions must be optimal because we’re still here.

Homebirth must be safe because we’re still here.

Exclusive breastfeeding must be best because we’re still here.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Looking at those today alive today though their parents never used seatbelts, we might conclude that seatbelts are unnecessary because “we’re still here.”[/perfectpullquote]

But “we’re still here” doesn’t merely fail to justify natural parenting practices, it is actually a form of cognitive bias, a way of thinking that inevitably leads us to erroneous conclusions.

Specifically, “we’re still here” is survivorship bias, a bias so subtle that it is often difficult for its practitioners to recognize.

Rational Wiki defines survivorship bias as:

… a cognitive bias that occurs when someone tries to make a decision based on past successes, while ignoring past failures.

It offers an excellent example:

Suppose you’re trying to help the military decide how best to armor their planes for future bombing runs. They let you look over the planes that made it back, and you note that some areas get shot heavily, while other areas hardly get shot at all. So, you should increase the armor on the areas that get shot, right?

Wrong! These are the planes that got shot and survived. It stands to reason that on some planes, the areas where you don’t see any damage did get shot, and they didn’t survive. So those are the areas you reinforce…

Dead men (and planes) may tell no tales, but the fact that they are dead provides valuable information for the survivors.

The planes that returned from the bombing runs aren’t the safest planes; they’re the ones that were merely lucky enough to get hit in the places least likely to cause catastrophic damage.

For example, imagine that every plane that returned was shot somewhere in the fuselage, but never in the fuel tank. In contrast, every plane that was shot in the fuel tank failed to return because a shot to the fuel tank inevitably led to explosion of the entire plane.

If you were to repair the returning planes and send them out on another bombing run a substantial proportion would once again fail to return because this time they might get hit in the fuel tank. Surviving the first bombing run because they were not shot in the fuel tank would not have made them more likely to avoid getting shot in the fuel tank the second time.

In other words, the pilots who survived the first bombing run were simply luckier than the ones who failed to return.

Consider a more common example.

Most of us above a certain age traveled in cars throughout our entire childhoods without ever using a seatbelt and we’re still here. For many years cars didn’t even have seatbelts yet the population of the US continued to increase. Does that mean seatbelts are useless?

Of course not! The many children who died from being ejected in car accidents are testament to the fact that failure to wear a seatbelt is dangerous. The dramatically lower death rates for children in accidents today compared to the 1960’s makes it clear that wearing a seatbelt is much safer than not wearing one. But if we only looked at people alive today even though their parents never used seatbelts, survivorship bias would lead us to conclude that seatbelts are unnecessary.

Dead children leave no offspring; the millions of their potential descendants are not here but we don’t notice …  because they are absent. We are the remainder.

How does this apply to natural parenting?

The claim that childbirth without interventions is safe because “we’re still here” makes as much sense as claiming that not wearing seatbelts in the 1960’s was safe because “we’re still here.”

The claim that homebirth is safe because for most of human existence women gave birth at home and “we’re still here” makes as much sense as claiming that putting babies to sleep on their stomachs instead of their backs is safe because “we’re still here.”

The claim that breastmilk must be better than formula because “we’re still here” is like claiming riding without a bicycle helmet must be better than using a helmet because “we are still here.”

But billions of potential people are NOT here today precisely because their parents died in childbirth, at homebirth, or from being exclusively breastfed by women who didn’t produce enough milk for them to survive.

We who are “still here” are the remainder, representing nothing more than luck, not inherent safety.

This week the mommy blogosphere was roiled by yet another claim that something “unnatural” causes autism. Exploring a Possible Link Between C-Sections and Autism was the irresponsible title chosen by The New York Times for its coverage. To date there is NO EVIDENCE that C-sections cause autism. No matter; it is fear mongering that sells newspapers.

But the truth is that such claims — irresponsible as they are — are a sign that natural childbirth advocacy is dying. Lactivists make similar claims about breastfeeding and that is a sign that lactivism is dying.

I’ve been writing about natural childbirth and breastfeeding promotion for nearly 25 years, long enough to discern major trends. As the years go by, the purported “benefits” of vaginal birth and breastfeeding are steadily decreasing and becoming ever more nebulous. This C-section autism claim is just another example.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Claims of lives and healthcare dollars saved have been debunked and replaced with nebulous assertions about the microbiome and epigenetics.[/pullquote]

Others include:

For years, natural childbirth advocates claimed that increasing the rate of vaginal birth would decrease the rate of maternal mortality. That claim has been debunked.

NCB advocates claimed that increasing the rate of vaginal birth would save millions of healthcare dollars. That claim has been debunked.

Lactivists predicted that increasing breastfeeding rates in industrialized countries would decrease mortality rates. That claim has been debunked, with the notable exception of very premature infants, the exception that proves the rule that breastfeeding has no impact on mortality rates.

Lactivists insisted that increasing breastfeeding rates in industrialized countries would decrease severe morbidity rates. That claim has been debunked; the only thing that has demonstrably decreased (and only slightly) is rates of colds and episodes of diarrheal illness.

Lactivists also claimed that increasing breastfeeding rates would save millions of healthcare dollars. Instead it is costing hundreds of millions of dollars to hospitalize tens of thousands of babies each year for breastfeeding complications.

Natural childbirth advocates and lactivists could acknowledge they were wrong. Instead, being ideologues, they will NEVER acknowledge they’ve been wrong. They’ve simply begun asserting ever more nebulous “benefits” to replace the concrete claims that have been debunked. That’s why — without any knowledge of the underlying science — they have misappropriated the microbiome and epigenetics.

They are like anti-vaxxers in that regard.

In “All manner of ills”: The features of serious diseases attributed to vaccination, authors Leask, Chapman and Robbins explain:

Parental anxieties about fearful, mysterious diseases that threaten children foment receptive audiences for such claims. These causal attributions do not rely on the strength of evidence for asserting causal association but share a number of epidemiological and societal features …

Autism is, of course, the paradigmatic disease. Why?

It has:

an idiopathic origin; apparent rise in incidence; face-value biological plausibility of a link to vaccines; [and] dreaded outcomes …

These features are intuitively appealing to anti-vaxxers because they do not rely on scientific understanding, but appeal to “common sense.” It doesn’t matter how many studies disprove the purported link between vaccines and autism. It is a dread disease, with unknown and complex causes and an apparently rising incidence. It is far more reassuring to pretend that autism has a simple and easily addressed cause, than to acknowledge that it can strike any child, cannot be prevented and cannot be cured.

These features are intuitively appealing to natural childbirth and breastfeeding advocates as well. As it becomes increasingly clear that neither vaginal birth nor breastfeeding have the benefits claimed for it, there is a need to fabricate new benefits and new mechanisms of action.

Both must be ever more nebulous. That’s where the microbiome and epigenetics come in. We are in the very earliest stages of understanding of these disciplines, similar to where we were when we first discovered radioactivity.

The discovery of radioactivity changed everything from medical imaging to nuclear power to atomic warfare. But before it was completely understood, it was misused in a variety of ways that range from humorous to horrifying. These uses ranged from radioactive toothpaste, advertised as providing a bright smile and freshening your breath by killing bacteria in the mouth, to radioactive cosmetics to make your complexion “glow” and prevent aging, to radioactive suppositories designed to deliver “healthful” radiation directly to internal organs. There is no way to know how many cases of cancer and how many deaths might have been caused by the enthusiastic adoption of radiation as a “cure.”

We appear to have learned nothing from that debacle even though the message could not be clearer: Do not implement new medical discoveries until they are thoroughly tested and understood. Natural childbirth advocates and lactivists are eagerly rushing to repeat the mistakes, using the microbiome and epigenetics.

The bottom line is that you shouldn’t believe ANY claims about either vaginal birth or breastfeeding and the microbiome or epigenetics. And you can rejoice that natural childbirth advocates and lactivists are falling back to ever more nebulous “benefits” of vaginal birth and breastfeeding as their substantive claims are debunked.

I feel sorry for Bauhauswife, Yolande Norris-Clark. Apparently she can’t bond to her own children without the exchange of bodily fluids.

I, on the other hand, had no such trouble.

I’ve always loved this quote from Maureen Hawkins:

Before you were conceived, I wanted you. Before you were born, I loved you. Before you were an hour, I would die for you. This is the miracle of love.

It beautifully describes how fiercely I bonded to each of my four children, even before they were born.

I would have — and to this day still would — give my life for them.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]For those who love their babies more than their mothering performance art, Fed Is Best![/pullquote]

I had no control over it. It happened without my doing a single thing.

The quote does not mention feeding method, yet lactivists appear to have trouble bonding to babies unless they breastfeed them. They must breastfeed for extended lengths of time to strengthen the tenuous bond. Indeed, their ability to bond with their own babies is so fragile that unless they immediately hold their babies skin to skin, they have trouble completing that natural bond.

That’s not to say that every woman bonds to every baby immediately. It can take days or weeks or more, but nearly every woman manages to bond fiercely to her child and nearly every child bonds to his or her mother with or without breastfeeding.

Why do lactivists have so much trouble doing what every other woman does naturally? What accounts for the irony that the women most committed to natural infant feeding can’t manage natural bonding without the exchange of bodily fluids?

Consider the Yolande, Bauhauswife. In her post, No, Fed is Not Best, But You’re Just Fine she writes:

As a culture, I believe we drastically misunderstand the importance of the breastfeeding relationship as simply a delivery system for what is arguably the nutritional “best”.

Instead, it’s my profound conviction that the actual food infants receive from their mothers is only a small part of a countless number of aggregate needs that breastfeeding fulfils, including physical warmth, love, care, socialization, relationship, the basis for a healthy sexuality, the origins of language, the foundation of empathy, and on and on.

Physical warmth? Seriously? I don’t know about you, but I mothered with my entire body, not only my breasts. Long after they had weaned themselves from breastfeeding — indeed until they were school age and beyond — my children clung to me when they needed physical and emotional warmth.

Socialization? One of my sons has Asperger’s Syndrome. I breastfed him just like I breastfed the others but as a child he had profound difficulty with socialization. It’s almost as if breastfeeding has nothing to do with socialization.

The origins of language? Another one of my sons has a profound language deficit. He was not speaking at the age of 4 and required years of speech and language therapy. It’s almost as if breastfeeding has nothing to do with language.

Relationship? Healthy sexuality? Does Yolande believe there was no sexual dysfunction and no sexual crime before the advent of formula? If so, she’s living in a fantasy world of her own creation.

The foundations of empathy? If that’s the case then Bauhauswife was not breastfed since she demonstrates precisely ZERO empathy for women who don’t mirror her own personal choices back to her.

I feel sorry for Yolande when she writes:

I know from experience that thawing milk, or mixing powder to put into a bottle and popping a silicone teat into my baby’s mouth is not even remotely similar to holding him to my heart, helping him latch on to my nipple, meeting his eyes as the electrical letdown buzz surges through my body and my milk starts to flow, in response to our mutual love.

I was fiercely bonded to my babies before I ever breastfed. Why wasn’t she? Why did she need to breastfeed in order to have the fullest, emotional relationship with her child?

Yolande worries:

Yet it’s almost forbidden in this era of validation-and-inclusion above-all-else, to suggest that not all choices are equal …

You’re right, Yolande! That’s why I feel no hesitation in refusing to validate the ugly nonsense that you spout.

Don’t get me wrong. You are entitled to feel however you wish to feel about the daughter you bottlefed. And I am entitled to feel sorry for that poor child since you consider your relationship diminished for the most trivial of reasons. No child deserves that.

That’s what happens when lactivists view their children as mere props in their mothering performance art. Like bridezillas who become enraged by a wedding cake that is the wrong flavor and think the wedding is ruined, lactivists become distraught when the baby “ruins” their experience. Sadly, lactivists seem to have trouble appreciating, bonding to, and loving their babies for who they are, instead of what they can do for them.

Yolande concludes:

I will never begrudge, or judge the individual women who chose to, or have to, pump, and bottle feed, for any reason under the sun.

Again, I did it, which is why its so important to me to speak the truth: bottle-feeding is not the same as nourishing a child with our breasts.

I can’t be so generous. I do judge women who can’t bond to their babies without breastfeeding. That’s why it is so important to me to speak the truth:

For those who love their babies more than their mothering performance art, Fed Is Best!