I’ve been writing for years about how the Baby Friendly Hospital Initiative (BFHI) is harming babies. The incidence of severe dehydration, sometimes accompanied by permanent brain damage, is rising. Also rising is the incidence of skull fractures of babies who fall from their mothers’ hospital beds and smothering deaths when mothers fall asleep while feeding or cuddling their babies. In a truly appalling development, exclusive breastfeeding has become the leading risk factor for newborn hospital readmission.

I’ve advocated for ending the BFHI on the twin grounds that it is not friendly to babies and it doesn’t work to promote breastfeeding. It’s going to be around for the near future, though. How can mothers learn to successfully breastfeed AND protect their babies and themselves from the harmful, unscientific Ten Steps of the Baby Friendly Hospital Initiative? Bring formula and pacifiers to the hospital!

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It’s YOUR body and YOUR baby. Take back control![/pullquote]

I recommend bringing formula and pacifiers for both practical reasons and philosophical reasons.

The practical reasons include:

• We KNOW that many women won’t have their milk come in for more than two days after birth, but babies may get hungry before then.
• We KNOW that up to 15% of first time mothers don’t make enough breastmilk to fully nourish and infant, especially in the days following birth.
• We KNOW, as even Dr. Alison Stuebe of the Academy of Breastfeeding Medicine acknowledges, that as many as 44% of babies will need formula supplementation in the early days.
• We KNOW that judicious formula supplmentation INCREASES rates of successful breastfeeding.

In other words, women who have easy access to formula supplementation in the first few days are MORE likely to breastfeed successfully, not less. The BFHI explicitly ignores this.

Sadly, breastfeeding promotion has become both humiliating and punitive.

• The BFHI mandates refusing to offer supplementation to hungry babies.
• It forces mothers to beg for formula and subject themselves to lectures on the benefits of breastfeeding (as if they aren’t already aware).
• It muzzles postpartum nurses from appropriately counseling women about the risks of dehydration and the benefits of supplementation.
• It mandates counseling mother about purported risks of pacifiers even though there is no evidence that pacifiers interfere with breastfeeding and a growing body of evidence that they reduce the risks of SIDS (sudden infant death syndrome).

These practices aren’t merely humiliating and punitive. They are fundamental violations of medical ethics and they rest on a deeply misogynistic view of women.

Lactation professionals cling to their beloved fiction that women don’t breastfeed or stop breastfeeding because they are too stupid and gullible to resist the marketing of formula manufacturers. The truth is quite different. The truth is that women don’t breastfeed because initiating breastfeeding can be frustrating for both mother and baby, and painful. They stop breastfeeding because continuing may be frustrating, painful,  inconvenient and may fail to provide the baby with enough nutrition.

Lactation professionals are afraid. They fear that if mothers see how easy, convenient and satisfying formula is, women will be seduced into using it instead of breastfeeding. So they prattle on about how easy and convenient breastfeeding is when it’s neither. They babble that breastmilk is the perfect food when it isn’t perfect if there is not enough of it. And, of course, they grossly exaggerate the benefits of breastfeeding when the truth is that in countries with clean water the benefits are limited to a few less ear infections and episodes of diarrheal illness across the entire population of babies in the first year.

Women are not selfish fools who must be forced into breastfeeding. Most women want to breastfeed and will make strenuous efforts to do so.

If you are one of those women I recommend that you take both formula and pacifiers to the hospital. Your baby will probably never need the formula, but knowing you have it will be reassuring. If your baby screams incessantly from hunger, you can offer a little formula to settle her and allow her (and you) to get some sleep. Pacifiers can also help in bridging the gap between your baby feeling distressed and your milk coming in.

The practical reason for bringing formula and pacifiers is that they can promote successful breastfeeding, but there’s a philosophical reason, too:

Having easy access to formula and pacifiers puts mothers, not lactation professionals, in charge of both babies and their own bodies. It eliminates the ability of hospital personnel to pressure and humiliate women into fulfilling the lactivist agenda and leaves personal decisions to the person actually affected by them, the mother.

HER baby, HER body, HER breasts, HER choice!

If you want to control your own body, protect your baby from the excesses of aggressive breastfeeding promotion AND ensure a successful breastfeeding relationship, take formula and pacifiers to the hospital. You may not need either, but if you do, you’ll be very glad you brought them.

I write a lot about scientific papers, policy and philosophy around childbirth, breastfeeding and mothering. But papers, policy and philosophical principles aren’t very helpful when you are up at 2 AM crying with exhaustion — trying to breastfeed a baby screaming from hunger — and convinced you are a bad mother.

That’s why I’ve created the 7 R’s. Think of them as a reality check and emergency boost for your maternal self-confidence.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Are you providing food, diaper changes, sleep and love? Your baby thinks you are a good mother, regardless of how others have taught you to judge yourself.[/pullquote]

1. REMEMBER what your baby actually needs

You’re crying because your baby is crying and you fear you are failing him or her. Let’s consider what your baby actually needs and whether you are fulfilling those needs.

Your baby needs to be fully fed, with regular diaper changes, plenty of sleep and lots of love. That’s it!

Your baby does NOT need an unmedicated birth, a vaginal birth, breastfeeding, skin-to-skin contact, baby wearing or any of the myriad rituals promoted by natural mothering advocates.

Are you providing food, diaper changes, sleep and love? Your baby thinks you are a good mother, regardless of how others have taught you to judge yourself.

2. RECOGNIZE propaganda

According to Wikipedia:

Propaganda is information that is used primarily to influence an audience and further an agenda, which may not be objective and may be presenting facts selectively to encourage a particular synthesis or perception, or using loaded language to produce an emotional rather than a rational response …

The best propaganda is hard to recognize because it seems like conventional wisdom. The conventional wisdom of natural childbirth, breastfeeding and natural mothering is exceedingly fine propaganda. Its loaded language includes:

• Natural
• Normal
• Physiological
• Traditional
• Best

This is the language of marketing, not science. A good rule of thumb is: if it is used to market products like yogurt or vitamin supplements, it has nothing to do with science.

Propaganda presents facts selectively, sometimes even presenting falsehoods as facts. It’s meant to influence the way that mothers’ view themselves and each other. Don’t fall for it.

3. RECALL the history of these movements

Natural childbirth, lactivism and attachment parenting were created by anti-feminists for the specific purpose of keeping women out of the workforce and stuck in the home.

Grantly Dick-Read, the father of natural childbirth, was a eugenicist who feared that upper class women with political and economic rights would have fewer children; he taught that childbirth pain was the result of “overcivilization” and he fabricated the claim that “primitive” women had painless labors because they knew their place.

La Leche League was started by members of a traditionalist Catholic women’s group as a way to convince mothers of babies to stay out of the workforce. They claimed no scientific benefits for breastfeeding, merely insisting that if Mary mother of Jesus breastfed, other women should emulate her.

Attachment parenting was created by Dr. William Sears, a fundamentalist Christian who has written that the philosophy was vouchsafed to him by God as His preferred method of family organization. He supposedly wants the father as the head and mother restricted to care of children.

Is this your philosophy, too? If not, there’s no need to feel bad for not conforming to the propaganda.

4. REALIZE: other women are trying to boost their self-esteem at your expense

Babies don’t care how they are born. They don’t care whether they are breastfed or formula fed. They don’t care if they have mandated skin-to-skin contact or if they are worn on their mothers’ bodies. Only adults care about those things.

Sadly, many women have been taught to boost their fragile self-esteem by submitting themselves to natural mothering propaganda. To maintain their self-image they believe they need other women to mirror their own choices back to them. Don’t let them boost their self-esteem at the expense of yours!

5. REMUNERATION: follow the money

What would happen to the salaries and employment prospects of midwives, doulas and childbirth educators if women discovered that babies DON’T benefit from unmedicated vaginal birth? What would happen to the salaries and employment prospects of lactation consultants if women discovered that breast ISN’T best for many babies? What would happen to the sales of books and services by self-appointed parenting “experts” if women discovered that MOTHERS know what their own children need far better than any parenting experts?

Now you understand why they enthusiastically use propaganda to manipulate you into improving their incomes.

6. RISKS: There are no benefits without risks

Anyone who tells you the benefits of unmedicated vaginal birth without detailing the considerable risks is manipulating you and potentially threatening your health and your baby’s health. Anyone who counsels you on the benefits of breastfeeding without disclosing the substantial risks (breastfeeding is now the leading cause of newborn hospital readmission) is manipulating you and threatening your baby’s health. Anyone who counsels you on the benefits of attachment parenting without mentioning the cost to your job, career and mental health is also manipulating you.

If you don’t understand the risks, guilt can be used to control your behavior. Do you want others to control your choices for their own benefit or do you want to choose what’s best for you and your baby?

7. REST: you can’t think clearly without sleep; childbirth is exhausting and leaves you vulnerable

Sleep deprivation is a form of torture and is routinely used by cults in order to subdue potential recruits. It’s not a coincidence that natural mothering advocates normalize maternal exhaustion; natural mothering functions as a cult and sleep deprivation makes it easier to manipulate women.

The pain of labor exhausts women and renders them vulnerable. Natural childbirth advocates pressure women to endure the pain; it makes it easier for midwives and doulas to manipulate them.

Childbirth exhausts women and renders them vulnerable. Natural mothering advocates pressure women to begin caring for their infants from the moment the placenta detaches. It makes it easier to manipulate them.

Breastfeeding around the clock exhausts women and renders them vulnerable. Lactation professionals are obsessed with exclusivity and promote barbaric regimens (triple feeding) that INCREASE exhaustion. Not, coincidentally, it makes it easier for lactation professionals to manipulate women.

The bottom line:

Are you a good mother who feels bad? It’s almost certainly because others are pressuring your for their own benefit. They will tell you what your baby supposedly needs and make you feel bad if you aren’t providing it.

I promise you that there is no benefit to natural mothering that your baby needs more than your physical and mental health. YOU are enough! Don’t let anyone convince you otherwise.

Lactation professionals have been successful in their attempt to “normalize” breastfeeding … and the harm has been incalculable while the benefits have been virtually imperceptible.

At this point, breastfeeding is the leading cause of newborn hospital readmission. 1 out of every 71 (!) exclusively breastfed newborns is readmitted to the hospital for complications of breastfeeding, amounting to tens of thousands of readmissions per year at a cost of hundreds of millions of dollars.

[perfect pull quote align=”right” cite=”” link=”” color=”” class=”” size=””]Normalizing breastfeeding hasn’t merely harmed babies’ physical health; it has taken a dreadful toll on women’s mental health.[/perfectpullquote]

In defense of lactation professionals, they had no idea that breastfeeding promotion would have such a harmful impact. What is indefensible is that now that they have learned that aggressive breastfeeding promotion hurts so many babies, they aren’t merely ignoring it, they are vilifying the physicians and lactation consultants who are trying to prevent infant starvation.

But normalizing breastfeeding hasn’t merely harmed babies’ physical health; it has taken a dreadful toll on women’s mental health.

Women’s Choice Regarding Breastfeeding and Its Effect on Well-Being details the problem.

It starts, as nearly every paper about breastfeeding does, by paying obeisance to the theoretical (to date too small to measure) “benefits” of breastfeeding. Then it details some of the psychological harms:

Andrews and Knaak interviewed 60 Canadian and Norwegian women and found that greater breastfeeding rates were supported by cultures of pressure and judgment in these countries. [A] … study in Scotland … found that women perceived that formula-feeding was not a topic to be discussed by health care providers and that they felt pressure to breastfeed… [H]ealth care practitioners’ interpretation of the U.K. Baby-Friendly Initiative may be preventing prenatal discussion about infant feeding choices.

Sheehan, Schmied, and Cooke, in a small qualitative study in Australia, found that some women initiate breastfeeding in hospitals to avoid judgment by their health care providers. [Others] … found that among women who had ceased breastfeeding by 3 months after birth, those for whom breastfeeding was strongly related with maternal identity … were seven times more likely to show psychological distress … In a qualitative study encompassing 10 focus groups conducted with 51 health care professionals involved in breastfeeding promotion, Marks and O’Conner documented concerns about the dichotomy between breastfeeding promotion versus coercion but reported that some women also believed that promotion was not always carried out appropriately.

The authors state:

Based on these studies, we believe it is reasonable to extrapolate that women who choose to breastfeed and have difficulty breastfeeding or who have negative early breastfeeding experiences and must discontinue breastfeeding prematurely may experience increased stress due to their own internal pressure to breastfeed or/and external pressure, potentially from well-meaning hospital health care staff who are expected to promote and support exclusive breastfeeding.

The ugly reality is that the Baby Friendly Hospital Initiative and similar programs are emotionally abusive.

Emotional abuse is often associated with a power imbalance. It involves shaming, blaming and gaslighting, all of which are integral to contemporary breastfeeding promotion. Indeed, the Ten Steps of the BFHI would be considered akin to psychological abuse were they applied in other healthcare situations.

• Imagine if overweight patients were repeatedly counseled throughout their hospital stay on the dangers of obesity.
• Imagine if they were shamed and told that their weight was their “fault.”
• Imagine if they were put on rigid diets, not allowed to supplement those diets and forced to sign consent forms signaling their awareness of the “dangers” of eating anything other than what was prescribed.
• Imagine if any time they deviated, they were publicly humiliated by healthcare personnel.
• And imagine when they complained of hunger, their hunger was both denied and derided.

Outrageous, right? But those tactics — shaming, blaming, and gaslighting — are integral to contemporary breastfeeding promotion in general and the Baby Friendly Hospital Initiative in particular.

But wait! Weren’t women “designed” to breastfeed? Sure, they were also “designed” to be heterosexual but that doesn’t mean that their sexuality is a choice that can be changed with “counseling” or that everyone should be pressured into using their organs for that which they were “designed.”

• Imagine if gay patients were repeatedly counseled throughout their hospital stay on the “dangers” of homosexuality.
• Imagine if they were shamed and told that their sexuality was their “fault.”
• Imagine if they were subjected to gay “conversion therapy.”
• Imagine if any time they resisted, they were publicly humiliated by healthcare personnel.
• And imagine when they insisted that they were gay, their sexuality was both denied and derided.

Emotionally abusive, right? But those tactics — shaming, blaming, and gaslighting — are integral to contemporary breastfeeding promotion in general and the Baby Friendly Hospital Initiative in particular.

The paradigmatic example of the emotional abuse of breastfeeding promotion is the phrase “perceived insufficient breastmilk.”

It is gaslighting in the extreme, since insufficient breastmilk is common, affecting up to 15% of first time mothers in the days after birth. It is also gaslighting because it implies that women cannot be trusted to understand that their babies are screaming babies in hunger.

It involves blame because the subtext is that women are using the claim of insufficient breastmilk as an excuse to stop breastfeeding.

And it is shaming; women who have insufficient breastmilk are encouraged to view themselves as defective.

The authors of the paper note:

…[I]t is important for these health care providers to acknowledge that research has shown that difficulties in breastfeeding are not uncommon and that failure to meet breastfeeding intentions correlate with increased postpartum depression symptoms…

Health care providers also need to be supportive of women who choose to supplement with formula or who eschew breastfeeding altogether. It is not possible for health care providers to be aware of all the
factors that play a role in forming a woman’s infant feeding intentions, but so long as a woman is provided appropriate education to make informed decisions, clinicians must trust that a woman will choose to do what is best, even if the woman’s definition of best is different than that of the health care provider.

Compassionate behavior should be the rule:

Failure to acknowledge that the majority of mothers will not breastfeed exclusively for 6 months may contribute to undue stress in mothers who may not be exposed to or even educated about best practices in formula-feeding or formula supplementation, which most mothers are likely to benefit from. Educating women on safe formula-feeding represents an opportunity to protect the health and well-being of infants who might otherwise suffer as a result of potentially poor practices by well-meaning mothers.

Yet such compassionate behavior is literally prohibited by the BFHI.

The authors conclude:

Women who have difficulty breastfeeding can be subject to pressure to continue, which may contribute to anxiety and/or depression symptoms. Despite clinicians’ best intentions to promote women’s and infants’ health by encouraging exclusive breastfeeding, health care providers must continue to offer emotional support and reassurance to those women who cannot or will not breastfeed exclusively to avoid unduly stressing mothers about their infant feeding choices…

Anything else is emotionally abusive.

Emotional grooming is the practice of manipulating an individual into a position of trust, vulnerability and isolation for the purpose of exploitation.

It’s commonly used to describe the tactics preparatory to child sexual abuse, but it applies whenever a powerful person maneuvers another into a situation that benefits the former at the expense of the latter. Sadly, it is used all too often by midwives and lactation consultants to convince women to do what benefits the provider at the expense of the patient and her baby.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Distrustful of other providers? Isolated from family and friends? Totally dependent on the advice from the midwife or lactation consultant?  You may be a victim of emotional grooming.[/pullquote]

How can you tell? If you find that you have become distrustful of other providers, isolated from family and friends and utterly dependent on the advice from the midwife or lactation consultant, you may be a victim of emotional grooming.

There are three red flags:

Encouraging mistrust of other providers.

An ethical medical professional does not disparage other medical professionals. Ethical medical professionals work together for the benefit of patients. No obstetrician would encourage you to distrust your perinatologist, or express disdain for the medical philosophy of the endocrinologist who follows you for diabetes.

Ethical medical professionals depend on each other to provide you with the best possible care. That’s why it’s a warning sign if a midwife encourages you to distrust obstetricians or a lactation consultant encourages you to distrust pediatricians.

If there is a disagreement between professionals over your care, they should discuss it between themselves; you might even wish to be present to evaluate their differing points of view. If your midwife or lactation consultant is unwilling to do that, you should consider whether she is encouraging you to distrust other providers for her own benefit (to keep you as a patient, to deprive you of information that might lead to you questioning your recommendations) rather than for your benefit.

It is especially worrisome if she encourage you to lie to other medical professionals. An ethical professional will NEVER counsel you to lie to another provider. No doctor can advise you appropriately if you are lying in response to their questions. There is absolutely, positively no benefit to you from lying to a doctor about anything.

When a midwife encourages you to distrust an obstetrician, or when a lactation consultant encourages you to distrust a pediatrician she is trying to isolate you from others. Why? So she can keep control of you as a patient.

Claiming special knowledge.

Does your midwife claim that obstetricians have never seen an unmedicated vaginal birth? If you think about it for a moment, the claim is absurd. Even in the US, with high rates of C-section and epidural use, fully 68% of women give birth vaginally. Approximately 40% give birth without an epidural. Moreover, in 2019 the majority of obstetricians are women. They haven’t just seen thousands of labors, they’ve endured a few themselves.

There is no midwife who knows more about SAFE childbirth than an obstetrician. Sure, midwives may have tips and tricks for support, but that has nothing to do with safety.

Does your lactation consultant claim that pediatricians are ignorant of breastfeeding? That might have been true 30 years ago, when actively promoting breastfeeding first became a priority for pediatricians, but it’s not true in 2019. In addition, the majority of pediatricians are women and many have breastfed their own children.

There is no lactation consultant who knows more about SAFE breastfeeding than a pediatrician. Sure, lactation consultants may have tips and tricks for support, but that has nothing to do with safety.

An ethical medical professional would never encourage you to risk your health or your baby’s health. An ethical professional wouldn’t tell you that you were brave, or a warrior mama, or demonstrating your trust in birth. An ethical medical professional would never tell you that you are “designed” to breastfeed. Those are all forms of emotional manipulation employed to strengthen the midwife or lactation consultant’s control over you for her benefit, not for yours.

Advocating ignoring relatives and friends.

The primary purpose of emotional grooming by midwives and lactation consultants is to isolate women and leave them vulnerable. Women in labor, and postpartum women are vulnerable by definition, leaving them easy to manipulate. But most women have partners, parents and friends who are prepared to advocate for them. Since relatives and friends aren’t as vulnerable, they can and will push back against midwifery and lactation recommendations that are unsafe both physically and psychologically.

One of the hallmarks of emotional grooming in any setting, not just a medical setting, is the efforts of the manipulator to separate you from the people who care most about you. Encouraging you to distrust your family and friends (“They aren’t as educated about childbirth as we are.” “They are steeped in a culture of fear.” “They are sheeple who cannot imagine defying authority figures.”) is encouraging an emotional barrier between yourself and those closest to you. The goal? Increasing the midwife’s or lactation consultant’s ability to manipulate you into doing what she wants, not what is best for you and your baby.

Do you trust your midwife? Do you think your lactation consultant knows what’s best for your baby? That’s great, but just be sure they are not emotionally manipulating you by encouraging distrust of other medical professionals, by insisting that they have knowledge other providers lack or by isolating you from family and friends. That’s not medical care; it’s emotional grooming and it’s harmful for you and your baby.

Lawyer and birth rights activist Bashi Hazard refuses to answer the question I posed:

What’s the difference between a doctor who performs a painful exam over a woman’s protests and a midwife who denies an epidural over a woman’s protests?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The ugly truth is that Hazard and Hill aren’t interested in what women want; they’re only interested in what they and their friends want.[/pullquote]

In the meantime, journalist Milli Hill, always desperate for attention, has joined the fray.

Hill:

I don’t really understand who ultimately gains from all the effort though? What is their goal – or who is getting their pockets lined – or both?

Hazard:

Well, take the NRA for example. How do you manage to keep selling guns to teenagers when your community is coping with 30-40 school mass shootings a year? By keeping the public on side through floods of “emotional messaging”: (1) Affirm their outrage (2) Tell them what to think

They seem to be under the mistaken impression that the bullshit with which they baffle their gullible followers will work on me.

Feminist academics have been exploring midwifery abuse of power for decades.

Among the most influential commentators on the subject are Ellen Annandale and Judith Clark, authors of the widely quoted paper, What is gender? Feminist theory and the sociology of human reproduction published in Sociology of Health & Illness Vol. 18, No. 1, 1996. The paper is long and filled with academic jargon, but has important insights that have created controversy among feminist theorists:

…[T]he lived experience of midwifery … is revealed only as the largely unresearched antithesis of obstetrics. An alternative is called into existence in powerful and convincing terms, while at the same time its central precepts (such as ‘women controlled’, ‘natural birth’) are vaguely drawn and in practical terms carry little meaning.

In other words, contemporary midwifery is unscientific and based on reflexive defiance. How did the it get to this point? Annandale and Clark believe that it starts with biological essentialism. Biological essentialism perpetuates women’s oppression by validating men’s belief that women are emotional and irrational. Or as Annandale and Clark write:

… Thus … reproduction is still centred for women and put on the agenda as if it were central to all women’s lives. This may serve to lock women into reproductive roles which may be politically problematic since the centrality of reproduction, contraception and childbirth to biomedicine is transferred to women’s experiences. This may be the reality of their experience, but equally importantly, it may not. To a certain extent this may be seen as an unavoidable consequence of a critique which appears as if it must engage the dichotomies of biomedicine to develop its own narrative.

Not only are the assumptions of biological essentialism wrong, they are also elitist:

… The charge of elitism evidenced in the privileged white middle-class voice of much research, and the silence around differences between women, applies well to Barbara Katz Rothman’s influential 1982 work … which ends with an implicit call for a home-based natural birth experience …. This is made in joyous terms with little recognition that many women may not be in the position to avail themselves of such an ‘alternative’ even if they wanted to.

Annandale and Clark ask a critical question about the new midwifery. Are midwives “with women” or exploiting women for their own ends?

If we conceive of power as a fundamentally male preserve we are led to gloss over ways in which women may exert power over others, including other women. In these terms, as recent institutional reforms stimulate community midwifery midwives may begin to consider the notion of affinity with women embedded in such concepts as ‘continuity of care’ … as masking the potential exploitation of midwives by their clients.

This is what Bashi Hazard and Milli Hill refuse to acknowledge. And because they cannot accept that midwives could abuse their power, they feel free to ignore the women who are abused by midwives.

One Twitter commentor wrote:

This happened to me and it certainly felt like assault. Midwife/doctor whoever is denying the pain relief, there needs to be serious concequences, it is a human right to have pain relief during childbirth, and in denying pain relief they are deliberately violating a human right.

Another wrote:

I’d also like to see them pulled up for ‘too early to have an epidural’ or the ‘let’s see how it goes’ routine. It’s nonsense- childbirth will generally get worse before it gets better and these tactics are designed to get the woman past the point of being able to have one.

The ugly truth is that Hazard and Hill aren’t interested in what women want; they’re only interested in what they and their friends want. And they’ll say and do anything — no matter whom they hurt in the process — to get it.

They know their position is indefensible so they try to divert with name calling and lies. That won’t work any more.

Yesterday I asked:

What’s the difference between a doctor who performs a painful exam over a woman’s protests and a midwife who denies an epidural over a woman’s protests?

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Hazard’s pious appeals are not about women; they’re about midwifery market-share.[/perfectpullquote]

I was responding to the claim by human rights lawyer Bashi Hazard that an increasing number of women are likening their experience of childbirth to assault by doctors.

I also posed the question to her directly on Twitter and she “responded” in the fashion typical of those who have been caught in hypocrisy — with a desperate effort to deflect:

I have arrived. A US RWNJ troll who claims to be an obstetrician has thrown down an imaginary gauntlet at me!

Is this woman really a lawyer? Most lawyers I know do research before responding so they won’t be caught uninformed. Hazard clearly didn’t bother.

I asked again:

If you care about women, you would be concerned about the widespread problem of midwives denying women epidurals. It seems you don’t.

Once again she tried to deflect:

Its you I dont care about. You are not an obstetrician. You are a troll and a RWNJ and a hired gun coming out of a country with a leader who bullies, trolls, lies and manipulates facts much like you. Your white self importance and entitlement is offensive. I waste no time on it.

Sure! If she didn’t care, she wouldn’t have responded, but apparently she was stung … as I intended.

The ugly truth — which Hazard is desperately trying to obscure — is that efforts to claim obstetricians commit assault/violence/birthrape have little if anything to do with women’s wellbeing and everything to do with midwives’ desperation to claw back market share.

Midwifery is an industry and midwives demonize their competitors. Indeed, much of midwifery philosophy is just reflexive (and unreflective) defiance of obstetricians:

Since obstetricians medicalize childbirth to make it safer, midwives de-medicalize it to make it more enjoyable, and, for added impact, declare childbirth was safe before obstetricians got involved.

Since obstetricians offer pain relief, midwives proclaim that pain improves the experience, simultaneously testing one’s mettle and making childbirth safer.

Since obstetricians whisk babies off to pediatricians to be sure they are healthy, midwives claim (without evidence) that skin to skin contact between mother and infant in the first moments after birth is crucial to creating a lifelong bond.

Since obstetricians placed the highest value on a healthy mother and a healthy baby, midwives place the highest value on a fulfilling birth experience.

In other words, no matter what obstetricians offer, midwives insist that it is unnecessary, disempowering and harmful. Midwives can thereby wrest childbirth back from doctors and give it to those to whom they believed it rightly belongs … the midwives themselves.

Wait, what? You think childbirth should belong to women? How naive. That would require holding midwives to account for their egregious behavior and apparently that’s not allowed.

A recent incident in New Zealand is emblematic of midwifery assault on women: Midwife disciplined after pretending to give woman pain relief during labour.

…[I]nstead of giving the woman the agreed pain relief of pethidine, the midwife gave her intravenous saline as a placebo but told her it was the pethidine.

…[T]he midwife said she “believed in the placebo effect”.

It gets worse. According to the midwife:

The way [the woman] was presenting led me to believe that she was transitional. Knowing this, I felt it was in the best interests of the baby not to give pethidine,” the midwife said.

“However, in the best interests of [the woman], I was to give her a sense of support and help in a difficult time, therefore I administered normal saline, leading her to believe it was Pethidine.

“I knew it would do no harm, and that pethidine could still be administered at any stage.

What did Bashi Hazard and her organization have to say about that? As far as I can determine, absolutely nothing!

Hazard has revealed her true goal — clawing back turf — in an article she wrote for Midwifery Today entitled Equality for Midwives:

Despite the knowledge and skills that traditional midwives have always used to serve their communities, there were medical emergencies that could arise in childbirth that they could not solve. Antibiotics, anti-hemorrhagic medicine, assisted and surgical deliveries and other medical technologies can prevent many of those deaths, and access to such technologies has saved many lives and massively reduced maternal and neonatal loss since their invention. But the terms on which these tools were offered to women, in the US and in many other places, created new forms of risk as all women were asked to place themselves in the care of medical professionals for pregnancy and birth, whether or not they needed medical treatment. Midwives were often disempowered (my emphasis)…

Midwives lost turf and income and they want it back:

Inequality exists in economics when doctors are rich, while midwives are poor. The valuing of, and compensation for, midwifery services should appropriately recognize their contribution to maternal health, enable midwives to continue in the field and develop experience and skills and construct midwifery as a stable profession that enables a woman to support her family, as doctors are able to support theirs.

Hazard’s pious appeals about assault in childbirth are not about women; they’re about market-share. Her goal is not the empowerment of women, but the enrichment of midwives.

That’s why Hazard has no interest in protecting women from assault by midwives, and was stung when I pointed out her hypocrisy. She felt compelled to respond, but her response merely confirmed my claims.

It happened 37 years ago, but I never forgot.

I was on my medical school obstetrics rotation and had just watched the birth of a baby. The mother had sustained a large second degree tear and the obstetrician was repairing it … without anesthetic. It would have been easy to give the mother local anesthesia but the doctor didn’t do it. The mother was screaming in pain yet the doctor was telling her she was “doing great.” There was no reason for the doctor to forgo the anesthetic beyond the fact that he couldn’t be bothered to administer it and wait for it to take effect.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]What’s the difference between a doctor who performs a painful exam over a woman’s protests and a midwife who denies an epidural over a woman’s protests?[/pullquote]

The doctor’s behavior was inexcusable.

That ugly incident came to mind as I read Assault during childbirth increasingly common in Australia says International human rights lawyer:

International human rights lawyer Bashi Hazard says an increasing number of devastated Australian women are likening their experience of childbirth to assault.

For example:

Brisbane mum Hayley Hackenberg, 34, was diagnosed with post-traumatic stress syndrome three months after giving birth to her second child Tobin.

“I was assaulted,” she says, tears filling her eyes. “It made me feel vulnerable and violated.” …

Hackenberg recalls a doctor coming into the room and telling her she was going to do a vaginal examination – in between talking to a midwife about what she was going to have for dinner.

“It really, really hurt, sending pain deep into my stomach. I asked her to stop, I screamed for her to stop, I whispered for her to stop, but she didn’t,” Hackenberg says. “She was looking at the midwife.”

At this point Hackenberg says she told the midwife: “I can’t do this anymore, I want a caesarean”.

She thought about suing the doctor:

She also spoke with a lawyer who said she could press criminal charges for assault but she decided not to.

Lawyer Hazard considers this situation, a patient in serious pain and a provider doing nothing to mitigate or relieve it, to be assault.

Hazard says the numbers affected are significantly higher and increasing but legal action for mental health issues and nervous shock cannot be brought without physical injury and women are often told there is no real injury.

Which raises the question:

What’s the difference between a doctor who performs a painful vaginal exam over a woman’s protests, all the while insisting she is “doing fine” and a midwife who delays or denies an epidural over a woman’s protests, all the while insisting that she is “doing fine.”?

There is no difference.

The practice is shockingly common:

A forum post that asked mothers “anyone else tricked out of epidural?” attracted 1,000 replies in under two weeks…

For example:

When Murphy entered the maternity ward to give birth to her daughter in February 2016, she was told that she couldn’t have an epidural until she was in active labor. When she entered labor, she requested one repeatedly. She never received it…

Months later, she questioned her care at a meeting with the Head of Midwifery at her ward. She was told that the staff had made a clinical decision not to give her the pain relief she requested. They thought she was going to deliver before it took effect.

And:

Danielle … planned to have an epidural. She even included it in her birth plan. Instead, she was refused all pain relief—including gas and air (a.k.a. nitrous oxide, which is widely used in the UK for pain relief during labor).

“Firstly because they told me I wasn’t in labor and to go home half an hour away,” [she] tells Broadly. “Then I was continually told over the phone I still wasn’t in labor [even though] I was in horrendous pain.” When she was finally examined, midwives told her it was too late for an epidural—or even gas and air.

If painful exams and failure to respond to patient entreaties is assault, midwives who delay or deny requested epidurals have also committed assault.

Human rights lawyer Bashi Hazard is correct that assault of women in labor is unacceptable.

Hazard claims hospital staff suffer excessive fear of liability and disciplinary action, so their response is to be more coercive to a mums-to-be as they deliver their babies.

“They no longer perceive the woman as their priority,” Hazard insists. “It is a really toxic workplace environment with everyone ready to point the finger at everyone else.”

In the case from my medical school rotation, the doctor denied the mother local anesthesia for a laceration repair because he didn’t want to be bothered and he believed the woman “didn’t need” pain relief.

When midwives delay or deny epidurals it’s because they don’t want to be bothered and because they believe women “don’t need” pain relief.

If Hazard and other birth activists truly believe that ignoring women’s entreaties about pain is assault, they should call out and even prosecute the midwives who do exactly the same thing.

You cannot understand the contemporary discourse around mothering in the US without understanding this central reality:

Every woman is the hero of her own mothering story.

That’s the essence of the mommy-wars. It has nothing to do with children, although children are ostensibly the focus; it has nothing to do with science, although science is often subverted for the purpose; it has everything to do with women and how they wish to see themselves, especially in comparison with other women.

[pullquote align=”right”]The mommy wars are fights to the emotional death so some mothers can claim heroic status.[/pullquote]

Every time I write about about shaming of formula feeding mothers, I am startled yet again by a total lack of lactivist regret. Lactivists aren’t moved to ask how they might craft a message that promotes breastfeeding without shaming women who can’t or don’t wish to breastfeed. That’s hardly surprising, though, if you understand that one of the central motivations of lactivism in the US is to portray the breastfeeding mother as a hero.

The mother as quest hero is at the heart of nearly all parenting movements based in part, or in whole, on pseudoscience.

Consider this description of a heroic quest:

• The call to adventure: The hero is “called” by [her]self or others to complete a task that will take [her] away from [her] regular “role” in [her] own society.
• The entry into the unknown: As a result of the call, the hero must leave the safety of [her] own known community and venture into a world of unknown dangers.
• Facing tests and trials: The hero faces a number of challenges on [her] journey… Heroes are often tempted to give up or give in.
• Sages: All heroes have guides to receive unexpected help on their journey…
• A supreme ordeal: This is the most difficult challenge or obstacle that the hero faces. Completing and overcoming this “trial” marks the end of the “testing” stage where the hero had to prove [her] worth…
• The return: The hero [her]self receives a reward of honour, acknowledgement, respect and perhaps love for [her] efforts…

Compare that to the classic “birth story” so beloved of birth bloggers, midwives and doulas. The mother is “called” to have an unmedicated vaginal birth and prepares by doing “her research.” She leaves the safety and comforts of medicated hospital birth. She faces tests and trials: refusal of standard preventive tests and interventions, arguments with relatives and friends about the wisdom of her choices, and the attitudes of hospital personnel who are nearly always constructed as unsupportive. She is tempted with offers of pain relief and C-section. Her midwife and her doula are sages who guide her on her quest. The supreme ordeal is navigating labor (the longer and more excruciating the better; the best is to ignore calls that your child is at risk) and “achieving” an unmedicated vaginal birth (preferably with minimal or no vaginal tearing). The hero receives honor, acknowledgment and respect for her achievement. Most importantly, she emerges “empowered.”

The mother is always the hero of her children’s birth stories, and by her heroism, she conveys her superiority over other mothers. Of course, for a mother to be a hero, unmedicated vaginal birth must be vastly superior. It isn’t superior at all, so birth activists subvert science to pretend that it is.

The heroic mother myth is at the heart of contemporary lactivism, where the mother faces pain, inadequate milk supply, and inconvenience, braves the temptation of formula feeding, is guided by a lactation consultant and achieves the quest of not a single drop of formula ever crossing her child’s lips. In order for a mother to be a hero, breastmilk must be portrayed as vastly superior to infant formula. It isn’t; in industrialized countries, the benefits are trivial, but lactivists subvert science to pretend that breastfeeding provides tremendous, lifelong benefits.

Even anti-vaccination advocacy depends on the quest trope. The mother goes on a journey of discovery by reading anti-vax screeds and websites, faces the pressures of relatives, friends and medical professionals, triumphantly refuses to vaccinate, and receives honor and acknowledgement in the anti-vax community for her heroism.

If the heroic mother fantasy affected only those who sought to make themselves mothering heroes, there would be no problem. Unfortunately, their efforts threaten two vulnerable groups. The first, and by far the most important, are children. Sadly, they serve as little more than props in the quest story. They exist to be acted upon and their actual well being is irrelevant.

Hence a natural childbirth aficionado will risk her child’s health and sometimes even her child’s life to complete her heroic quest. A lactivist will let her baby cry desperately in hunger and even let him starve, sometimes nearly to death, in order to complete her lactation quest. Anti-vax parents live in a dream world unmoored from reality where those who expose their children to harm are heroes.

The other group affected by the fantasy of the heroic mothering quest is the women who don’t view mothering as a quest. They can and should ignore those women who are desperate to cast themselves as heroes, but that’s harder than you might think. Why? Because the quest mothers have hijacked public health messages, particularly in the area of breastfeeding.

A heroic mothering quest appears to require shaming women who make different choices. That’s why lactivists don’t ask how breastfeeding promotion might be modified to minimize shaming. They WANT other mothers to be ashamed; they’re HAPPY they are ashamed; the last thing they want to do is to mitigate that shame. If mothers who formula feed aren’t failures at the quest, how can mothers who breastfeed be heroes?

Framing mothering as a quest has NOTHING to do with actually mothering children. It has NOTHING to do with science. The mommy wars are fights to the emotional death so some can claim heroic status while grinding others into the dust. It’s ugly; it’s wrong; and we should refuse to countenance it.

Natural mothering advocates like to imply that the natural is political. For example, they absurdly claim “peace on earth begins with birth.” The implication is that because we’ve deviated from natural childbirth, we’ve been punished with an epidemic of violence. It’s nonsensical because for most of human existence, childbirth has been entirely natural and violence was far more common in the past than it is today.

But when it comes to mothering, the natural IS political. The “natural” in natural mothering has very little to do with what actually happened in nature, but is a cultural construct meant to control the behavior of women.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Natural mothering is political, not because it improves the world, but because it designed to suppress women.[/pullquote]

That’s among the arguments made by Harriet Pattison, PhD of Liverpool Hope University in her chapter The Natural Child from the book Childhood Today.

Both childhood and nature are cultural constructs that have little if anything to do with childhood in nature.

Scholars note that our beliefs about childhood in nature are cultural, without reference to what actually happened in nature.

… [T]he present-day view of childhood is overwhelmingly that childhood is not natural … a social construct. This means that our knowledge of children is shaped not by understandings inherent to the state of childhood but by much wider forces… Beliefs about children … what they need and how to treat them – come not from general facts about children but from interpretations made through … politics, economics, culture, philosophy and religion.

Our view of nature itself is culturally determined.

…[N]ature, like childhood, is not a fixed, immutable entity but a responsive concept, tied to our wider thinking, to our political and social concerns … What also becomes simultaneously clear is that if nature is a construct of human thought then any understanding of nature is liable to be a changeable, shifting phenomenon, open to making and remaking in varied and restless forms

Why does it matter how women mothered children in nature?

If childhood can be successfully grounded in such a solid base as that of nature, then considerable control has simultaneously been gained over … how it should be enacted. Thus the contention here is that new, contemporary calls to natural childhood and natural children embody political desires …

Natural mothering is about the politics of controlling women. Perhaps the biggest irony of this effort is that self-proclaimed natural mothering “experts” invoke science to argue about what is supposedly the province of nature:

The paradox however is … that the scientifically objectified natural child ‘has helped to create an intellectual climate in which childhood was no longer seen to occur naturally. It did this by promoting the idea that childhood needed the attention and intervention of experts’. So we have moved from the natural child whose development is governed by a pre-determined unfolding biology to a child whose development has to be carefully nurtured and managed by trained specialists.

University College London psychoanalyst Ruth McCall amplifies these themes in her chapter Pyschoanalysis and Feminism: A Modern Perspective from the book The Unconscious in Social and Political Life.

Currently there is a fashion for attachment parenting, a mode of looking after babies with maximal psychological empathy and long-term physical closeness. The American paediatrician William Sears and his wife Martha explicitly developed attachment parenting in response to Bowlby’s research findings and advocate that there is no higher purpose for a woman than as mother … Some academic feminists are aghast at this turn. Harvard gynaecologist Amy Tuteur has stated that “Attachment parenting amounts to a new subjection of the woman’s body under social control,” and a recent book by Élisabeth Badinter, The Conflict: How Modern Motherhood Undermines the Status of Women, specifically attacks attachment parenting for its retrogressive effects on women’s lives.

But this is not merely a theoretical issue. It leads to tremendous suffering for women.

The terrible feelings of failure and regret that are experienced by women who have difficult births or who cannot or do not choose to breastfeed are very significant. Attachment parenting, designed to be a liberal alternative to nineteenth-century regimens of controlled feeding and crying can also produce anguish.

As Petra Buskens notes in The Impossibility of “Natural Parenting” for Modern Mothers:

Numerous histories of “the family” show us that intensive, romanticized caregiving carried out by biological mothers in the private sphere is an “invention” of modern economic and political arrangements. It was only with the division of public and private and the shift from a domestic to an industrial economy, that mothers were cordoned off to a special occupation called “Motherhood.”

Prior to this, women mothered with a community of men, women, and children and did so in and around a myriad of other subsistence oriented tasks. However, with the social changes brought about by the creation of a public sphere (populated by male citizens) together with industrialization and a free-market economy, women in western societies were no longer welcome to participate in economic and social life; instead they were sequestered to the private sphere as glorified mothers … This pedestal was a dubious and double-edged position generating a situation of profound, albeit romanticized, exclusion.

It reflects political and cultural conservativism:

The emphasis on maternal nurture … provides an invisible subtext of romantic opposition to western modernity. In other words, contained within this radical critique is a thinly veiled conservatism concerning the “natural” place of women … As with earlier historical periods of modernizing social change, mothers thus come to represent … the “traditional” within the “modern.”

William Sears is a paradigmatic example of this thinking:

Sears is specifically opposed to mother’s working outside the home and encourages 24-hour embodied care … Together they amount to an utterly exhausting regime of caregiving and patience for the mother. Her role as isolated caregiver precludes her participation in both paid work and socializing but we are assured this is a “natural” and “traditional” state of affairs. One wonders how such a blatant ignorance of history could go unnoticed by both Sears and his readers, but we have only to remember the emotional power of the word “mother.” In the name of this word, Sears manages to reconstruct the past and foreclose much of the future for new mothers.

The bottom line is that natural mothering is political, not because it improves the world, but because it designed to suppress women. Natural mothering has never been about what’s good for babies; it’s about forcing women back into the home in service to tradition but under the guise of “nature.”

I’ve written over and over again about the way that lactation professionals lie to women, promoting breastfeeding over the wellbeing of mothers and babies.

Every time a lactation professional claims insufficient breastmilk is rare when it is common, she lies.
Every time a lactation professional claims second night syndrome isn’t hunger, she lies.
Every time a lactation professional says neonatal stomach volume is 5-7 ml when it is 20+ ml, she lies.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Real medical professionals don’t punish colleagues for telling the truth about side effects. Lactation professionals prefer lying.[/pullquote]

But if you want to understand how integral lying is to lactivism, look no further than the case of Midwife Cath, an Australian midwife now facing disciplinary action because dared to tell the truth.

… Curtin has been ordered to undergo additional training by the Nursing and Midwifery Board of Australia.

The order comes after five people complained about a post Curtin made on social media about breast feeding.

Let’s think about that for a moment. Anti-vax doctors routinely question vaccination on social media but they aren’t disciplined.

Chiropractors and homeopaths routinely post self-serving nonsense on social media but they aren’t disciplined.

And midwives themselves routinely question obstetric standards of practice on social media, but they aren’t disciplined.

Why, because health professionals have a right to freedom of speech.

So what did Midwife Cath do that was “worse” than that?

In the [Instagram] post, Curtin wrote “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 (which doesn’t increase your milk supply by the way) remember that #fedisbest”.

Put in other terms, Curtin was suggesting women feed their babies with formula rather than letting them go hungry waiting for breastmilk to come through.

How dare she tell the truth about the fact that insufficient breastmilk is common?

No less an authority than Alison Stuebe, MD of the Academy of Breastfeeding Medicine has acknowledged:

Delayed onset of lactogenesis is common, affecting 44% of first-time mothers in one study, and 1/3 of these infants lost >10% of their birth weight. This suggests that 15% of infants — about 1 in 7 breastfed babies — will have an indication for supplementation.

How dare she tell the truth that there is no evidence that pumping (which is not natural) leads to milk coming in faster? It’s possible though no one has ever shown it to be true.

How dare she tell women that judicious formula supplementation in the early days after birth IMPROVES the chances of exclusive, extended breastfeeding?

According to the paper The Effect of Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota: A Randomized Clinical Trial:

[T]hese results suggest that using ELF in a carefully structured, temporary manner may not interfere with breastfeeding or maternal experience in the first month or have a negative impact on intestinal microbiota… Using small volumes of formula on a temporary basis for newborns with pronounced weight loss may have the potential to help clinicians and mothers provide the nutritional volume needed by babies without interfering with duration of breastfeeding or with the health benefits achieved from longer breastfeeding duration.

No matter. Lactivists believe it is better to lie to women and let their babies starve.

But probably Midwife Cath’s most unforgivable sin is that she adopted the slogan of the “other side,” Fed Is Best.

Why is that her most egregious offense? Because contemporary breastfeeding promotion is about market share and the economic benefits for lactation professionals. They imagine themselves to be in a turf war with formula companies and they strive to win that war at all costs — even if the cost is collateral damage to babies: letting them starve, sustain brain injuries and die rather than give them lifesaving formula.

How is Midwife Cath to be punished?

She must indoctinated to ensure that mothers aren’t told the truth.

[She] must be mentored by another registered midwife in relation to contemporary best evidence of infant feeding (breast feeding and bottle feeding), safe sleeping and advertising responsibility (including endorsement advertising)…

The mentoring must comprise a minimum of six sessions with each session being of one hour duration occurring over a six month period.

George Orwell couldn’t have come up with a better form of “discipline.”

To understand just how immoral such behavior is consider:

What if doctors who questioned the benefits of routine episiotomy and feared the risks had been “disciplined” for refusing to lie to patients?

Women would still be getting routine episiotomies with the increased tearing that results.

What if doctors who discovered that ulcers were caused by bacteria were “disciplined” for refusing to pretend to patients that anti-acids were the cure?

The toll in pain, suffering and death would never have been decreased.

What if doctors who questioned the benefits of hormone replacement therapy for postmenopausal women were “disciplined” for refusing to lie and tell patients that the benefits outweighed the risks?

The breast cancer rate would have continued to rise.

Real medical professionals don’t censor their colleagues, because real medical professionals understand that questioning received wisdom is integral to providing the best possible care.

But lactation professionals aren’t real medical professionals; they are self-promoters. That’s why a midwife who dares to tell patients the truth about breastfeeding must be punished.