Sleep is so important for healing, for mental health and possibly even for pain perception that it is functionally a healthcare treatment.

New mothers need to heal from childbirth, manage the pain that often results and are at risk for serious mental health disorders like postpartum depression and anxiety. They need sleep.

So why have we allowed hospitals — through the Baby Friendly Hospital Initiative — to create a sleep environment for new mothers that normalizes maternal exhaustion?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Only one culture cruelly expects exhausted new mothers to fully care for their babies from the moment the placenta is delivered. Ours.[/pullquote]

And what can we do to create a more sleep supportive environment?

Everyone knows about the benefits of sleep.

“Sleep services all aspects of our body in one way or another: molecular, energy balance, as well as intellectual function, alertness and mood,” says Dr. Merrill Mitler, a sleep expert and neuroscientist at NIH.

And the benefits aren’t limited to the brain:

“Sleep affects almost every tissue in our bodies,” says Dr. Michael Twery, a sleep expert at NIH. “It affects growth and stress hormones, our immune system, appetite, breathing, blood pressure and cardiovascular health.”

Sleep may affect pain perception and it has a profound effect on mental health.

That’s probably why nearly all cultures, ancient and modern, mandate a period of confinement for new mothers.

Those who practice it typically begins immediately after the birth, and it lasts for a culturally variable length: typically for one month or 30 days, up to 40 days, two months or 100 days. This postnatal recuperation can include “traditional health beliefs, taboos, rituals, and proscriptions.” The practice used to be known as “lying-in”, which, as the term suggests, centres around bed rest.

China:

“Sitting the month”: 坐月子 “Zuò yuè zi” in Mandarin or 坐月 “Co5 Jyut2” in Cantonese. The custom, going back to the year 960, is referred to as ‘confinement’ as women are advised to stay indoors for recovery from the trauma of birth and feed the newborn baby.

East Asia:

Other East Asian cultures, such as South Korean and Vietnamese, have their own versions of “sitting the month”, combining prescribed foods with proscribed activities. Similar practices are popular among Japanese women called 産後の肥立ち “Sango no hidachi” and Korean women called 삼칠일 “Samchilil” for at least 21 days. The new mother is given special postnatal foods, such as seaweed soup in Korea. Samchilil is practiced in addition to other traditions encompassed in sanhujori, which is Korea’s version of postnatal care. During this period of time that could extend beyond the 21 days, women followed principles that emphasize activities and foods that keep the body warm, rest and relaxation to maximize the body’s return to its normal state, maintaining cleanliness, eating nutritious foods, and peace of mind and heart.

India:

Most traditional Indians follow the 40-day confinement and recuperation period also known as the jaappa (in Hindi). A special diet to facilitate milk production and increase hemoglobin levels is followed.

Latin America:

The cuarantena (literally, forty days, also meaning quarantine) is practised in parts of Latin America, and amongst immigrant communities in the United States.] It is described as “intergenerational family ritual that facilitated adaptation to parenthood”…

In other words, most cultures believe that we should mother new mothers, and adequate sleep is considered critical for both recovery of the mother and production of breastmilk for the baby.

Only one culture cruelly expects exhausted new mothers to fully care for their babies from the moment the placenta is delivered. Ours.

Our culture has normalized maternal exhaustion, portraying it as necessary for breastfeeding.

According to The Milk Meg, Meg Nagle:

Feeding your baby back to sleep. Not a mistake, the biological norm! Most babies will need a mid-nap breastfeed and frequent feeds during the night. For months or years.

Prof. Amy Brown speaks disparagingly of mothers who need sleep:

“We are told by so-called experts that you should get your baby in a feeding routine and your baby should not wake up at nights,” said Brown. “But that is really incompatible for breastfeeding. If you try and feed them less, you make less milk. You need to feed at night to make enough milk.”

And the Baby Friendly Hospital Initiative, designed to promote breastfeeding, has encouraged closing well baby nurseries where mothers can leave their babies while they sleep. The BFHI promotes mandated rooming in, leaving mothers fully responsible for the care of their babies from the very first hours after birth.

The BFHI has led to a mini epidemic of babies smothering to death in their mothers’ hospital beds and fracturing their skulls by falling from them.

A recent article asks, Has the push for breastfeeding gone too far?

“One of the requirements is that 80% of the babies need to be at least 23 hours of the day with the mom,” said neonatologist Enrique Gomez Pomar.

That is a chilling statistic. How can a new mother be expected to get hours of unbroken sleep if she is solely responsible for the care of a newborn? She can’t and lactation professionals don’t care about the harm that causes.

“The problem with this comes when you have a mother that had a C-section or when you have a mother that was laboring for two days and is exhausted,” he said.

Like the two moms mentioned earlier, and others. Finding them was no trouble, basically just a matter of posting on neighborhood Facebook groups, looking for recent delivery experiences.

Such stories are common, Pomar said, because giving moms a break — taking healthy babies to the nursery — is a “ding” against the Baby-Friendly designation.

“They’re very strict about their numbers,” he said. “Say the mom says that she wants to rest, then you take the baby to the nursery. That baby, that case, actually dings the hospital.”

What kind of healthcare system penalizes a hospital for allowing new mothers to sleep? Our system under the Baby Friendly Hospital Initiative.

But sleep is critical for healing, for mental health and potentially for pain management. If we care about women — as we claim we do — we MUST create a sleep supportive environment for new mothers.

That means reopening well baby nurseries in ALL hospitals.

That means encouraging mothers to use those nurseries if they feel a need for additional sleep.

That means prioritizing the health of women’s entire bodies and minds, not merely their breasts — as if they are nothing more than milk machines.

As cultures around the world both past and present demonstrate: exclusive, extended breastfeeding isn’t merely compatible with mothering new mothers; it is enhanced by it.

There is precisely ZERO evidence that normalizing maternal exhaustion improves anything. That’s why it’s imperative that we support sleep for new mothers!

Far be it from me to bewail the power of social media and tech.

It is social media and tech — first the platform Blogger, then my own website, as well Facebook and Twitter — that has brought my concerns about the dangers of homebirth, natural childbirth, breastfeeding and anti-vax to such a wide audience. I have become so well known that those who feel threatened have gathered 6000 signatures on a Change.org petition to have me censored from Facebook.

The petition claims:

Facebook has recently started removing the pages and groups of people they claim to be spreading “fake news” or “false science,” yet somehow, the page run by Amy Tuteur (which she titled “The Skeptical OB”) stays up. Amy regularly spreads false information (proven time and time again by science). She has been quoted as saying “rape is natural” and a “successful evolutionary strategy.”

Birth and breastfeeding professionals — who are too cowardly to face me in any debate and too unsure of themselves to rebut my claims in any setting — are hoping to prevent me from offering comfort and support to the many women they harm in their pursuit of profit. If they think that will that will stop me, they don’t know me very well.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Ironically, natural childbirth advocates and lactivists are proving my point: they have become blind to the real meaning of the word “natural.” [/pullquote]

But the petition has nothing to do with why I am in Facebook jail. I have been temporarily banned for pointing out that just while unmedicated vaginal birth and breastfeeding are natural, so is rape.

Entire books have been devoted to this issue, including A Natural History of Rape: Biological Bases of Sexual Coercion.

As I explained in a recent post:

If we define rape as forced copulation, it isn’t merely natural among humans, it is natural throughout the animal kingdom…

In species where females pick or accede to males based on fitness, rape represents an important evolutionary strategy for less fit males. Instead of leaving the choice of mate to the female, the male who forces copulation on a female who wouldn’t otherwise choose him is given a chance to spread his genes that he wouldn’t otherwise get. If he is a successful rapist, he will father many offspring. Rape offers this male an extra opportunity to be an evolutionary winner. So rape isn’t merely natural in such settings, it is a winning strategy.

Predictably, some people were upset, reasoning — wrongly — that if rape is natural, it must follow that rape is excusable. Ironically, they were demonstrating the point I had set out to prove: that natural childbirth advocates and lactivists have become blind to the real meaning of the word “natural.”

Natural is NOT equivalent to “good.” Just because something is natural does NOT make it best nor something we can or should wish to emulate. Rape is always wrong. Even if rape occurred in the past in nature, and occurs to this day in the animal kingdom, it is still always wrong and SHOULD be punished harshly and prevented by the best means we have at our disposal. And just because unmedicated vaginal birth and breastfeeding occur naturally does not make them best or even good.

So how did I end up in Facebook jail? The same people who are organizing and supporting the petition to censor me, reported my posts for using the word rape. Facebook did not elaborate on why I was temporarily banned for using the word “rape,” but under its Community Standards I found:

We remove content that displays, advocates for, or coordinates sexual acts with non-consenting parties …

Of course I did none of those things, so why was I banned anyway?

Sadly, the same social media and tech that have empowered me have inadvertently also empowered the mob. How? By automating decisions about speech.

Facebook has over 2.2 billion users and has been struggling to monitor and address outrages that occur on or are promoted by its platform. There probably aren’t enough people in the world to put eyes on all the content posted to Facebook each day so Facebook relies on complaints from individuals, subjecting the purportedly offensive content to tech that autonomatically screens it, probably using key words. The word rape is almost certainly a key word and if someone uses it in a way that makes someone else complain, the user is banned.

There is an appeals process, and I have engaged it, but it’s the weekend and the ban will be over before Facebook ever addresses it.

I did not violate Facebook’s Community Standards because I was not promoting rape; I was discussing a scientific theory about rape. Once someone complains about the use of the word rape, the automated technology wrongly concludes that rape is being promoted and bans accordingly.

Facebook made a mistake that they never intended to make. But such mistakes are inevitable when you automatically act on complaints without determining whether or not those who are complaining have a legitimate reason to do so.

As for the petition, I am considering my options in consultation with my lawyers since it is defamatory. Facebook certainly hasn’t acted upon it and I suspect they never will.

No petition will ever keep me from speaking out in support of women bullied by natural childbirth advocates and lactivists and against the harmful effects of pernicious ideologies that subvert science. The fact that 6000 birth and breastfeeding advocates are so afraid of me that they want to censor me only confirms my effectiveness.

No one truly knows how hard a doctor works on behalf of patients than another doctor.

I understand how obstetricians struggle to make the right decision on when and how to deliver a baby to maximize the health of both infant and mother. I know what it’s like to confront at a worrisome fetal monitor tracing, unable to determine whether it represents real fetal distress but having to act anyway. I’ve lived the gut churning terror of a shoulder dystocia. I’ve been woken out of a deep sleep, snapped to awareness and raced to save a woman who showed up on the hospital doorstep hemorrhaging from a massive abruption, desperately hoping I’m not too late to save the life of her baby, too.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]We give our all in service to our patients. Then we hand them over to the lactation lobby that harms both babies and mothers. [/perfectpullquote]

We and our pediatric/neonatology colleagues give our all in service to our patients. Then, too often, we hand them over to the lactation lobby that harms both babies and mothers. I’m referring, of course, to the so-called Baby Friendly Hospital Initiative designed to promote breastfeeding.

But wait, I hear you say. Doesn’t the conventional wisdom tell us breast best?

If you are as old as I am, you probably remember when the conventional wisdom was that routine episiotomies were best, that routine hormone replacement therapy for menopause was best, that routinely putting babies to sleep on their stomachs was best.

All too often the conventional wisdom is wrong and this is another case. Routinely pressuring all women to breastfeeding exclusively is wrong. Routinely withholding pacifiers and infant formula is wrong. Closing well baby nurseries and routinely forcing 24/7 rooming in is wrong.

How wrong?

This wrong:

• The revised United States Preventive Services Task Force (USPSTF) guidelines
• Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms
• Unintended Consequences of Current Breastfeeding Initiatives
• Health Care Utilization in the First Month after Birth and Its Relationship to Newborn Weight Loss and Method of Feeding
• The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature
• The Effect of Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota: A Randomized Clinical Trial
• Breastfeeding during infancy and neurocognitive function in adolescence: 16-year follow-up of the PROBIT cluster-randomized trial

Taken together, these papers demonstrate that insufficient breastmilk is common (up to 15% of first time mothers), formula supplementation makes successful breastfeeding more likely, pacifiers prevent SIDS, extended skin to skin contact lead to babies falling from their mothers’ hospital beds or suffocating while in them, and the latest results from the PROBIT studies show no impact on IQ at age 16. In addition, we know that the leading cause of jaundice induced brain damage (kernicterus) is breastfeeding.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The BFHI is a creation of La Leche League; it’s a full employment plan for its leaders allowing them to monetize the information they previously gave away for free.[/pullquote]

So wrong that exclusive breastfeeding is now the LEADING risk factor for newborn hospital readmission, accounting for literally tens of thousands of hospital readmissions for dehydration, jaundice and failure to thrive each year.

And those benefits we were taught about in medical school? Nearly all have been debunked.

It’s been 5 years since the publication, Is Breast Truly Best? Estimating the Effects of Breastfeeding on Long-term Child Health and Wellbeing in the United States Using Sibling Comparisons by Colen and Ramey that found the purported benefits of breastfeeding nearly all disappeared with corrected for confounding variables like socio-economic status and ethnicity.

A recent paper, Is the “breast is best” mantra an oversimplification?, is a comprehensive summary of breastfeeding research and concludes that the benefits have been overstated and the risks ignored.

The evidence for infant breastfeeding status and its association with health outcomes faces significant limitations; the great majority of those limitations tend to overestimate the benefits of breastfeeding. Nearly all evidence is based on observational studies, in which causality cannot be determined and self-selection bias, recall bias, and residual confounding limit the value or strength of the findings.

And there is growing evidence that the BFHI is harmful to mothers as well as babies:

The literature that does investigate harm consistently finds that women who have difficulty breastfeeding or choose formula feeding report feelings of inadequacy, guilt, loss of agency, anxiety, and physical pain during breastfeeding that interferes with 1) their ability to bond or otherwise care for their infant and 2) competing work obligations…

Why have we been promoting breastfeeding so aggressively?

The BFHI is a creation of La Leche League and is essentially a full employment plan for its leaders, allowing them to monetize the information they previously gave away for free.

…[T]he BFHI was crafted in close conversation with individuals from La Leche League’s inner circle. First, early work by UNICEF and the WHO to develop the BFHI includes language which reproduces key components of La Leche League’s commitments…

[I]t’s also possible to trace the influence of individual policymakers from La Leche League in the 1970s to UNICEF in the 1980’s…In fact, the extensive connections between La Leche’s leadership and the WHO and UNICEF are well documented in the archival record of the League. These collections detail the involvement of the organization’s leadership, including its president Marian Thompson …

At the same time, LLL was engaged in an effort to monetize breastfeeding support, creating the lactation consultant credential.

The International Board of Lactation Consultant Examiners® (IBLCE®) was founded in March 1985 using a $40,000 loan from La Leche League International as start-up funding…

These factors of consumer demand, scientific evidence and practical clinical skills converged to create an ideal climate for the new profession…

Not exactly. The heart of the BFHI program — the Ten Steps to Successful Breastfeeding — were operationalized BEFORE there was any scientific evidence to support them.

It was not until nearly a decade after the birth of the program, in 1998, that the WHO published a review of scientific evidence in support of the Ten Steps. Their review of the scientific literature at that point served not to inform or influence the design of the BFHI but instead to defend the initiative as it had been initially drafted.

Think about that: a program designed by LLL to be staffed by its members was implemented without ANY scientific evidence to support it. It’s no wonder then that the BFHI has ended up harming our patients.

Fellow physicians, we have the power to protect our patients from the BFHI and we should use that power. The BFHI is a private organization; they can be removed from hospitals altogether or they can be forced to amend their guidelines to put preventing harm to babies and mothers first.

You work so hard to ensure the health of every baby and every mother. Please don’t let the lactation lobby continue to harm them.

Behold birth rape!

According to HuffPo UK:

Birth rape, they call it … Rape is really to do with having your body disrespected, contorted against your wishes, without your consent. The way the medical establishment sees it is, when you’re on the hospital bed, you have already given consent. Some men say the same thing about the marital bed, or any bed that you get into with them.

There’s even a website called Birth Rape:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]This isn’t the first attempt to censor me and it won’t be the last. It also won’t be effective.[/pullquote]

The idea of being raped while giving birth is difficult to imagine. In most people’s minds, rape means forced sexual intercourse where a penis is inserted, forcefully and without consent, into another person’s body. Some broaden that definition to include objects as well as body parts… And it doesn’t just happen in dark alleyways, bedrooms tinged with the smell of alcohol and ‘mixed signals’, or in war zones. It can (and does) happen in some of the most respected and revered institutions in the land – hospitals.

And another website called Birth Raped:

Birth rape is the violence and assault women are subjected to by those they are trusting to safely care for them while they give birth…

Those who abuse pregnant and birthing women under the guise of care giving need to be called to account. Sadly, most people are unwilling to admit women are routinely assaulted by doctors, nurses and midwives. Women need to tell their stories so that one day these abusers can’t hide behind claims of doing their jobs to avoid the legal and professional repercussions of their abuse.

In each case, natural childbirth advocates are claiming that the way they were treated during birth isn’t merely “like” rape; it is rape. I’m not aware of a single celebrity natural childbirth advocates criticizing the use of the term “birth rape” or cautioning that it is disrespectful to or triggering for women who have survived sexual assault.

You can understand, then, why I’m not moved by the faux outrage about my post pointing out that rape is natural; forced copulation occurs across the animal kingdom including humans and in some cases is an evolutionarily successful strategy. I noted that just because something is natural does not mean it it good or worthy of being emulated. Unmedicated vaginal birth and breastfeeding may be natural, but rape is, too. At no point did I suggest that unmedicated vaginal birth and breastfeeding are the same as rape or that rape is acceptable because it occurs in nature.

No matter. Those who fear me and the power of my words have set out to censor me. Kaci Dean CLC, Doula, Herbalist has set up a Change.org petition to get me banned from Facebook.

Who is Kaci?

Kaci is a birth/postpartum doula, placenta encapsulator, herbalist and certified lactation counselor. She has two beautiful daughters and 4+ years of personal breastfeeding experience. Her thirst for knowledge was born when she was left wanting more following the cesarean birth of her first baby. Her passion for birth and postpartum care bloomed after the gentle home birth of her second daughter. She strives for excellence in every aspect of her work and celebrates each client with the love and support every blossoming mother deserves.

Why should I be banned?

Amy regularly spreads false information (proven time and time again by science). She has been quoted as saying “rape is natural” and a “successful evolutionary strategy.”

But that’s not the real reason. As she acknowledged on her personal Facebook page, she just wants to shut me up:

Help me take down the Skeptical OB. I’m done with her trash littering our society.

For people like midwife Hannah Dahlen, it’s not enough to hide from me by blocking on social media, she is so afraid of what I say that she wants to prevent anyone from hearing it.

We are calling on Facebook to remove The Skeptical OB. I am all for debate and respectful disagreement but Dr Amy demeans, defames, attacks, insults and promotes ideas that are contrary to the evidence and recommendations. Her hatred for midwives, normal birth and homebirth and anyone who supports either of these is well known. It needs to stop #ENOUGH

I understand why they want to silence me. As Nobel Prize winner J. M. Coetzee has observed:

The punitive gesture of censoring finds its origin in the reaction of being offended. The strength of being-offended … lies not in doubting itself; its weakness lies in not being able to afford to doubt itself.

They’re not really offended; their unwillingness to call out their own colleagues for comparing hospital birth and C-sections directly to rape makes it clear that it doesn’t matter how the word is used, just who is using it. They’re afraid of me and my critique of the many ways they bully women and profit from that bullying.

These natural mothering advocates are hardly the first to attempt to censor me and they won’t be the last.

As I wrote more than 6 years ago before embarking on a lawsuit against a blogger who tried to censor me:

…[T]here has never been any chance that The Skeptical OB would disappear. There may continue to be disruptions until the matter is sorted out, but my writing will continue to appear in the marketplace of ideas that is the Web.

It ain’t over ‘til it’s over and this ain’t over.

Pandemonium has broken out on my Facebook page because I dared to point out that rape is both natural and evolutionarily successful in some settings. Natural childbirth advocates and lactivists are so blinded by their kindergarten level view of evolution — everything natural must be good — that they are reeling in indignation.

The responses have ranged the tiny gamut from nonsensical to truly absurd. The nonsensical responses insist that since everything natural must be good and rape is bad, rape can’t possibly be natural. The absurd responses assert that rape doesn’t exist in the animal kingdom or among human beings prior to the development of advanced civilizations.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Pointing out that choking is natural does not make me a “choking apologist.” Similarly pointing out that rape is natural does not mean I think rape is good.[/pullquote]

But rape is hardly the only ugly, harmful thing that occurs in nature. Human beings are perfectly designed to choke.

Direct connections between the mouth, esophagus, and stomach put the lungs at risk for aspiration during swallowing and regurgitation, and excess gas can be swallowed. The pharynx and mouth are used in common for eating, vomiting, and breathing, and food and liquids entering the mouth must be diverted away from the lungs by the epiglottis to avoid flow into the lungs. Major and minor episodes of aspiration contribute to the terminal stages of many diseases, and aspiration appears to play a role in a variety of chronic disorders, such as cough, bronchial asthma, bronchiectasis, and pulmonary fibrosis…

It is a very poor design from an evolutionary point of view.

…[T]he crossing of the respiratory and digestive tracts in the human throat can cause death from choking on food. It would be better design — much safer in terms of survival — if our air and food passages were completely separate.

But evolution can only work with what exists:

…[A]ll vertebrates … from fishes to mammals on the phylogenetic tree … have crossing respiratory and digestive tracts… The crossing of passages is a historical legacy … Not in itself an adaptation, it is a by-product of selection’s having molded [current anatomy] from what came before.

Evolution does NOT produce perfection; working with existing structures and behaviors, it only produces “good enough.”

Just as crossing respiratory and digestive tracts are “good enough” to ensure the survival of the species, childbirth that has a high instrinsic mortality rates is also “good enough.” Similarly, breastfeeding that has a high rate of insufficient breastmilk is also “good enough.” Evolution does not lead to “perfect design”; it leads to imperfect design that is better than other possible adaptations given the constraints of existing design and the existing environment.

The erroneous view that evolution produces perfection was criticized by biologist Stephen J. Gould as the Panglossian paradigm. The paradigm references Pangloss, a character in Voltaire’s Candide who believes that “all is for the best in this best of all worlds.” In the context of evolution the Panglossian paradigm imagines that everything that exists in nature today is the product of intense natural selection and represents the perfect solution to a particular evolutionary problem.

The propensity for human beings to rape and murder each other is not a perfect solution or even a good solution to the problem of survival of the individual or the species. But it isn’t a bad solution, either, because evolutionary traits are neither good nor bad.

That’s why my pointing out that choking is natural does not mean that I am a “choking apologist” or think choking is a good thing. Similarly pointing out that rape is natural does not mean that that I am a rape apologist or that I think rape is good. The entire point of my piece is that whether or not something is natural tells us NOTHING about whether or not it is perfect or even good.

That’s why natural isn’t always good and technology is often better. Rape is natural and even evolutionarily beneficial in some circumstances. But technology allows us to catch and punish rapists severely. Unmedicated vaginal birth is natural and even evolutionarily beneficial in some circumstances. But technology like interventions and C-section allows us to dramatically lower both the neonatal and maternal mortality rates. Interventions and C-sections are often better than unmedicated vaginal birth. Breastfeeding is natural and even evolutionarily beneficial in some circumstances. But formula allows us to dramatically lower the infant mortality rate and in many circumstances is better than breastfeeding.

The bottom line is simple — so simple that even those with a kindergarten level understanding of evolution could understand: Just because something occurs in nature doesn’t make it good. Unmedicated vaginal birth and breastfeeding are natural, but so are rape and choking.

“It’s natural.”

That’s often the beginning and the end of many arguments about the relative merits of C-sections and epidurals vs. unmedicated vaginal birth. It’s also supposed to be the beginning and the end of any argument about the relative merits of breastfeeding vs. formula.

The declaration “it’s natural” is presumed to have cricital advantages over other claims: being inarguable and reflecting science not morals. As natural childbirth and breastfeeding advocates delight in saying, “Facts are not attacks” and the claims that unmedicated vaginal birth and breastfeeding are natural are certainly facts.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Is rape best because it is natural?[/pullquote]

“It’s natural” is also imagined to have prescriptive value. If it’s natural, it must be good because it is what we are “designed for.” Millions of years of evolution can’t be wrong, can it? That’s why we should “normalize” unmedicated vaginal birth and breastfeeding. It is culture that has caused them to fall our of favor, but culture must bow down before nature.

So if unmedicated vaginal birth and breastfeeding are best because they are natural, what does that tell us about rape? Rape is natural, too.

If we define rape as forced copulation, it isn’t merely natural among humans, it is natural throughout the animal kingdom.

From insects to birds to higher animals, reproduction in many species depends on the female choosing her mate. This evolutionary strategy involves females judging males for fitness based on species specific displays like plumage. The peacock with the most elaborate plumage is more attractive to peahens because they are fittest evolutionarily. A peacock with elaborate plumage will pass on its “fitter” genes to the peahens’ offspring.

In other species, males fight to demonstrate their evolutionary fitness with the winner claiming the right to mate with a specific female or all females within a harem. The strongest male is winner in more ways than one; not only does he get the mating opportunities, but he is able to spread his genes into more offspring. In evolution, the individual with the most offspring wins.

In species where females pick or accede to males based on fitness, rape represents an important evolutionary strategy for less fit males. Instead of leaving the choice of mate to the female, the male who forces copulation on a female who wouldn’t otherwise choose him is given a chance to spread his genes that he wouldn’t otherwise get. If he is a successful rapist, he will father many offspring. Rape offers this male an extra opportunity to be an evolutionary winner. So rape isn’t merely natural in such settings, it is a winning strategy.

If unmedicated vaginal birth is best and breast is best, then rape must be best, too!

That can’t be right, can it?

It can’t and it isn’t and the reasons demonstrate why unmedicated vaginal birth and breastfeeding aren’t necessarily best, either.

Evolutionary fitness is all about leaving the most offspring who survive to adulthood. Nature is agnostic as to how that is accomplished.

For example, if the successful moose rapist leaves more offspring than the moose who battled all the other males to win the right to mate, the rapist is the winner. Moreover, he didn’t have to risk his health or his life for the opportunity to mate.

Similarly, nature doesn’t care how a mother and baby survives childbirth, only IF they survive childbirth. Nature doesn’t care whether or not a baby is breastfed, only that the baby is FED.

While specific strategies may be evolutionarily better overall, ignoring those strategies may be better for individuals.

Letting females choose their mates may lead to greater success for a species as a whole, but each individual within the species is struggling to pass on his genes and success for him might require rape.

It makes no difference to the individual woman or baby whether unmedicated vaginal birth or breastfeeding is a successful strategy for the species overall. To them, it only matters if they survive. If C-sections and formula increase the chance of survival, then they are better.

What is adaptive in one setting can be maladaptive in another.

Rape may be an evolutionarily successful strategy among animals. It is less likely to be successful in human societies that have laws to prevent cuckholding. While a rapist in human society might be successful if not caught, he might be killed in a society that punishes rapists with death.

Unmedicated vaginal birth and breastfeeding were the most successful of all possible strategies among human beings until the advent of technology. Now that technology can improve upon or even replace natural processes, refusing to use lifesaving technology is maladaptive.

Just because a tactic is evolutionarily successful doesn’t make it good, particularly when considering the victim.

Males stand to benefit when they rape. The species as a whole may benefit, too, since valuable traits that aren’t connected with display or strength may be carried on. There does not seem to be any benefit at all for the female who was raped; she is deprived of the opportunity to make her own mating choice and she was violated and perhaps injured. Just because rape is natural, doesn’t make it something we wish to emulate or even allow.

Similarly, unmedicated vaginal birth and breastfeeding can be natural, but that doesn’t make them best nor something we can or should wish to emulate; that’s especially true because the natural deprives women of the opportunity to make the choices they deem best for themselves.

The bottom line?

Natural isn’t best, even in nature.

It’s good for some, bad for others, and therefore nobody else’s business what a woman chooses for herself.

Can you imagine the American College of Obstetrician-Gynecologists insisting that they must support the practice of routine episiotomies — even though they harm women — because obstetricians like them? I can’t. That would be deeply unethical.

Can you imagine the The American Academy of Otolaryngology insisting that they must support the practice of routine tonsillectomies — even though the risks to children’s lives far outweigh any possible benefit — because Ear, Nose and Throat specialists profit from them? I can’t. That would be deeply unethical.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Supporting “safe” bedsharing is no different from supporting “safe” drunk driving.[/pullquote]

Can you imagine the Academy of Breastfeeding Medicine insisting they must support the practice of routine bed sharing — even though it kills babies — because lactation professionals like it?

Despite the fact that would be deeply unethical, you don’t have to imagine it. Incredibly, for lactation professionals, promoting breastfeeding is more important than whether babies live or die.

The ABM has made their ugly position clear in a recent commentary by Ann Kellams, MD.

She starts with a lie:

…[T]he recommendations for infant feeding and safe sleep can be confusing and may appear to be at odds with one another.

There is NOTHING confusing about the recommendations for safe infant sleep. Every pediatric and public health organization — valuing babies lives above whether or not they breastfeed — is very clear that bedsharing kills babies and should NOT be practiced.

In contrast, every major lactation organization — valuing breastfeeding over whether babies lives or die — supports the deadly practice of bedsharing.

They have lots of excuses:

We know that mothers who bedshare with their infant breastfeed for longer. We also know that where babies start off the night is not always where they end up in the morning. We know that breastfeeding is protective against Sudden Infant Death Syndrome (SIDS), but also that bedsharing may pose a risk for a sleep-related infant death, particularly in the setting of other risk factors such as prenatal smoking, formula feeding, maternal substance use, sedating medications, maternal obesity, prematurity, and the presence of soft bedding in the sleep environment. Some organizations recommend bedsharing as a means of supporting breastfeeding and cite data about the physiologic patterns and postures of mothers and babies when they bedshare…

So what? How does that justify hundreds of preventable infant deaths each year? It DOESN’T.

Dr. Kellams seems to think we face an ethical conundrum:

What then is a mother to do? And how as physicians should we counsel them?

There is no conundrum. The ethical position for doctors is to counsel mothers that bedsharing might kill their babies. The ethical position for mothers is to try to prevent bedsharing in order to avoid the deaths of their babies.

But Dr. Kellams and the Academy of Breastfeeding Medicine apparently believe that promoting breastfeeding is more important than preventing infant deaths. For them, a few hundred dead babies each year pales into insignificance compared to goosing exclusive breastfeeding rates higher. Why? Because breastfeeding is “healthier.” They seem neither to know nor care that dead babies can’t breastfeed.

No matter. Is a flourish of mind-blowing hypocrisy, Dr. Kellams suggest that we should “listen to mothers.”

That’s hilarious! The same people who insist that we should NOT listen to women who don’t wish to breastfeed and utterly ignore those women who report pain, exhaustion and insufficient breastmilk as reasons for choosing formula suddenly think we should “listen” to mothers who bedshare? The same people who insist that we should hammer new mothers with masses of information about the benefits of breastfeeding, force them into hospital settings in which they will be pressured to breastfeed and shame them for not breastfeeding expect us to believe they care at all about what mothers think?

But Dr. Kellams and the ABM are undeterred:

…Starting with listening can help the physician determine the level of risk given the particular situation and tailor the education and advice. Even the organizations that recommend no bedsharing recognize that mothers are at risk of falling asleep while feeding and that the safest place to fall asleep while feeding is an adult bed with a flat, firm mattress and no soft bedding, i.e. pillows, blankets, or comforters in the environment. The groups that advocate for bedsharing as a strategy for successful breastfeeding also caution about soft bedding, the gestational age of the infant, breastfeeding vs. formula feeding, the avoidance of smoking and sedating medications or substances, etc…

By that “reasoning,” we should listen to drunk drivers.

Can you imagine ANY physician advocating counseling those who habitually drive drunk to make sure their brakes are in working order and buckle their seatbelts because they are probably going to drive drunk anyway?

What would you think of any physician who insisted that the key to preventing drunk driving deaths was to support safe drunk driving? I imagine you would conclude that such physicians were behaving unethically.

And what would you think of such a physician if you learned that she earned a substantial proportion of her income from bar owners and purveyors of alcoholic beverages in exchange for promoting drunk driving? I don’t know about you, but I would conclude she had a massive conflict of interest and that her “advice” should be ignored as utterly self-serving.

Because that’s what is going on here. The Academy of Breastfeeding Medicine has a massive conflict of interest. They profit from promoting breastfeeding regardless of who gets hurt — or who dies! — in the process.

They should be ashamed of themselves.

But that would require valuing babies lives above breastfeeding. Unfortunately, they appear so blinded by their own interests that they consider a few hundred dead babies a year a small price to pay to promote breastfeeding.

When you spell it out, it sounds appalling. The Baby Friendly Hospital Initiative, designed to promote breastfeeding, is very unfriendly to mothers, dangerous to babies, and ignores the scientific evidence. Why then has it become so popular?

A new philosophy paper, Understanding the Baby-Friendly Hospital Initiative: A Multi-disciplinary Analysis, attempts to answer this question.

The authors take great pains to soft pedal the ugly realities and — in an effort to protect themselves against the inevitable lactivist accusation that they must “hate” breastfeeding — repeatedly insist that they support breastfeeding.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Why has the BFHI — unfriendly to mothers, dangerous to babies, and contemptuous of scientific evidence — become so widespread and politically correct?[/pullquote]

Wading through the apologetic language makes it clear that the BFHI is unfriendly to mothers:

…[S]ome women claim that Baby-Friendly policies have contributed to negative postpartum experiences, arguing that Baby-Friendly hospitals are not “mom-friendly.” For example, some mothers report that they are being inappropriately pressured to breastfeed, or express frustration with hospitals who refuse to provide or support formula supplementation. In addition, mothers have argued that 24-7 rooming-in practices do not take seriously the needs of mothers to rest and recover …

[I]n a survey of postpartum patients in a Baby-Friendly Hospital, 28% responded “neutral or disagree” when asked if they could rest and recover in the hospital. Among mothers who had decided to formula feed, 26% reported feeling shamed for the decision to formula-feed and 37.5% did not feel adequately informed about formula-feeding.

Moreover, with its insistence that “breast is best” for every mother and baby, the BFHI fails to provide appropriate understanding and support for women at high risk of poor outcomes:

For example, staff at the Massachusetts General Hospital’s Center for Women’s Mental Health have described Baby-Friendly policies as being insensitive to the needs of patients who are at elevated risk for postpartum depression, as such mothers are particularly in need of time to rest and recover after delivery…

If that weren’t bad enough, the BFHI places babies at risk for deadly complications because it ignores scientific evidence:

…For instance, researchers have reported that there may be a link between skin-to-skin contact in the hours after birth, which is promoted by BFHI policies, and Sudden Unexpected Post-Natal Collapse (SUPC), a life-threatening condition for a newborn. Additionally, the emphasis on breastfeeding, together with rooming-in policies, may encourage unsafe co-sleeping practices by postpartum mothers, some of whom are recovering from major surgery. Finally, current Baby-Friendly policies ban pacifier use, even though pacifiers appear to lower the risk of Sudden Infant Death Syndrome.

How could a program that treats mothers badly and poses deadly risks to babies have become both popular and politically correct? It reflects our cultural construction of motherhood:

…[O]ur normative conceptions of motherhood dispose us to undervalue and overlook maternal interests when benefit to children is at stake, and thus we overlook the costs of BFHI practices to mothers, or treat these costs as obviously acceptable given the potential health benefits …

How could a program that places babies at risk of serious injuries and death have been allowed to continue?

Since the modern breastfeeding movement began in the 1950s, some advocates have embraced the argument that breastfeeding is natural, and that natural things are endowed with a kind of biological morality that makes them superior, better, and healthier by default… This view of breastfeeding as natural, and of “the natural” as superior, healthier, and less risky may help to explain how questions of safety for mothers and infants have been left unasked, and may have shaped the creation, implementation and support for the BFHI.

Rather than addressing the problems inherent in the BFHI, the process of implementation has amplified them:

…[U]nlike research science, which emphasizes well-designed studies and careful analysis, quality improvement emphasizes quick implementation of what is termed “best practices.” The motivation for this approach is based on two beliefs: first, that healthcare faces a quality crisis in which patients are routinely poorly served and, second, that scientific research proceeds too slowly to be of practical benefit. Thus, instead of waiting for research science to conclusively prove the benefit of an intervention, the emphasis in quality improvement is on learning from “success stories” at other facilities… This process typically unfolds over a period of months, and it is contrary to the norms of the field to wait for an extensive evidentiary base to be developed.

Institutionalization leads to “one size fits all” policies:

…[Q]uality improvement places great emphasis on the standardization of care pathways… [P]ressure towards standardization can lead providers to overlook subpopulations of mothers who are ill-served by the standard approach, such as those suffering from depression or anxiety.

…[W]hile some quality improvement initiatives are small and flexible, … others are embedded in multi-layered institutional structures… As quality improvement work becomes more institutionalized, with multiple layers between practitioners and administrators, it also becomes less flexible. In the case we have been discussing, first-line practitioners have identified a potential problem with the existing intervention—it may not be well-suited for mothers with depression—but they are effectively powerless to act on this knowledge. If they stop following the standard protocol for these mothers, they will damage their TJC accreditation scores, and possibly endanger the accreditation of the hospital as a whole…

The ultimate irony of the BFHI is that a program that was designed to facilitate choice for mothers has become a program that pressures mothers to make only ONE approved choice. A program designed to give women the option and support for breastfeeding has become a program to pressure women into breastfeeding. A program designed to give mothers the option of rooming in with babies has become a program that forces women to take full responsibility for the care of babies before they have recovered physically from birth.

The authors offer specific suggestions for improving the BFHI:

First, because an ethic of total motherhood encourages new mothers to downplay their own interests, the BFHI should counteract this tendency by including language which recognizes and values the interests of mothers…

Second, we have argued that institutional pressures tend towards one-size-fits-all policies which become institutionally rigidified. One way to counteract this would be to explicitly acknowledge, within the Ten Steps, that mothers have diverse needs and preferences…

Third, while we believe it is possible for breastfeeding promotion to be conducted in ways which respect the full diversity of maternal interests, we are pessimistic about breastfeeding promotion within medical contexts which are subject to compliance-oriented quality improvement…

This paper is timely, thoughtful, acknowledges the dismal realities of the BFHI and suggests correctives.

In my view, however, it ignores two critical factors. In an effort to ward off the inevitable accusation that they authors “hate” breastfeeding, they repeatedly affirm their support for breastfeeding without ever addressing the fact that most claims of benefits for term babies in industrialized societies have been debunked. The reality is that breastfeeding is not beneficial enough to warrant major efforts to increase breastfeeding rates.

The second omission is more problematic. Although the authors address the institutionalization of the BFHI, they fail to acknowledge the monetization of breastfeeding support and the resulting economic conflict of interest between lactation consultants’ desire to increase demand for their services and women’s desires to control their own bodies and make the feeding choices that are best for their specific circumstances.

Nonetheless, the authors have performed a valuable service is setting out the parameters of the debate. Why has the BFHI — unfriendly to mothers, dangerous to babies, and contemptuous of scientific evidence — become so widespread and politically correct? Because of outmoded views about women, erroneous views about natural processes, and the imperatives of large institutions, not because it’s best for babies … since often it isn’t.

The best selling non-fiction book of 1974 was Maribel Morgan’s Total Woman.

The Total Woman is a self-help book for married women by Marabel Morgan published in 1973… Overall, it sold more than ten million copies… [I]t taught that “A Total Woman caters to her man’s special quirks, whether it be in salads, sex or sports,” and is perhaps best remembered for instructing wives to greet their man at the front door wearing sexy outfits; suggestions included “a cowgirl or a showgirl.” “It’s only when a woman surrenders her life to her husband, reveres and worships him and is willing to serve him, that she becomes really beautiful to him,” Morgan wrote.

The book grew out of an “insight” from Morgan’s own marriage: She could have a happy husband and conflict free marriage only if she knuckled under to her husband’s every whim.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It is no longer fashionable for women to imagine themselves as chattel of the patriarchy. Instead, they are taught to imagine themselves as the slaves and doormats of their children.[/pullquote]

The Total Woman embraced four basic principles:

…ignoring the mistakes of the husband and focusing on his virtues, admiring him physically, appreciating him, and adapting to the idea that the husband was the king …

For example:

For both Marabel and her followers, sex is a vital part of the TW treatment: …[wives] are told to be ready and willing for love-making at any hour … (Marabel herself reveals that she has seduced Charlie under the dining-room table by candlelight (“A very creative girl,” he brags) and sent sexy notes to his office.

Other homework assignments include greeting husbands in provocative costumes. One woman stripped to the buff and wound herself in Saran Wrap and a big red ribbon. An NFL player, whose wife had taken the Total Woman course, decided to reverse the game plan and met her at the door wearing only a hair ribbon, an apron and galoshes.

The difference between a Total Woman and any other wife was not what she was willing to do, however, but why she was willing to do it. It’s the difference between being turned on by dressing in a sexy maid’s costume and being humiliated by being forced to dress in a sexy maid’s costume; it’s the difference between welcoming sex and submitting to unwelcome sex.

In order to ensure a successful marriage and a happy husband, a Total Woman must turn herself into her husband’s doormat, servant, and always willing sex slave. The Total Woman understood husbands had needs that must take precedence over anything a wife could possibly want.

The philosophy of the Total Women didn’t merely subjugate women; it made women the agents of their own subjugation.

From our vantage point in 2019, it’s easy to understand that The Total Woman was a backlash to the women’s liberation movement of the 1960’s and 1970’s. Led by activists like Betty Friedan, Gloria Steinem and the lawyer Ruth Bader Ginsburg, women were asserting the right to make decisions for themselves based on their own needs and desires. They would no longer accept that their role was limited to being chattel of the patriarchy.

It’s less obvious that the “Total Mother” (aka the “natural” mother) is the contemporary iteration of knuckling under to the patriarchy. In most circles, particularly on the Left, it is no longer fashionable for women to imagine themselves as chattel of the patriarchy. Instead, they are taught to imagine themselves as the slaves and doormats of their children.

As Joan Wolf has written:

…Total motherhood is a moral code in which mothers are exhorted to optimize every dimension of children’s lives, beginning with the womb, and its practice is frequently cast as a trade-off between what mothers might like and what babies and children must have. When mothers have wants, such as a sense of bodily, emotional, and psychological autonomy, but children have needs, such as an environment in which anything less than optimal is framed as perilous, good mothering is construed as behavior that reduces even minuscule or poorly understood risks to offspring, regardless of potential cost to the mother.

The underlying assumption of Total Motherhood is that in order to have happy children, a mother must surrender herself to the agony of childbirth (even going so far as to pretend that it is isn’t painful; it’s pleasurable), surrender her body to extended, exclusive breastfeeding for years at a time, and surrender her entire life to continuous proximity to her child whether awake (baby wearing) or asleep (family bed).

Moreover:

…[W]omen’s needs — to work, control their bodies, or sustain an identity independent of their children — become “weaknesses in individual maternal character, to be corrected through educational messages”. This kind of reasoning, which implies that either ignorance, cowardice, or selfishness is behind a mother’s decision not to do what is best for her baby, rests firmly on assumptions about total motherhood …

The difference between a Total Mother and any other mother is not what she is willing to do, however, but why she is willing to do it. It’s the difference between not wanting an epidural and being denied (or denying oneself) an epidural; it’s the difference between breastfeeding because you want to and breastfeeding because you feel you must; it’s the difference between choosing to give up job or career to stay home with your children and being forced (or forcing oneself) to give them up because that’s what “good mothers” are supposed to do.

It is not an accident that philosophy of natural childbirth was created by a misogynist (Grantly Dick-Read) who wanted to force women out of public life and back into the home. It is not an accident that La Leche League was created by traditionalist religious women who thought convincing women to breastfeed would force them out of public life and back into the home. It is not an accident that attachment parenting was promulgated by Bill and Martha Sears who insist that “wives should submit to their husbands in everything…”

The best part from the point of view of the patriarchy? The philosophy of the Total Mother doesn’t merely subjugate women; it makes women the agents of their own and other women’s subjugation.

Although natural childbirth advocates, including midwives like Sheena Byrom and Hannah Dahlen imagine themselves as empowering women, they are subjugating them by normalizing childbirth agony.

Although lactivists like Amy Brown pretend to themselves that they are empowering women, they are subjugating them by normalizing suffering and exhaustion.

Although activists like Jennifer Block and Alisa Alpert whom I wrote about yesterday believe they are empowering women by pretending that postpartum depression is a metaphysical conundrum instead of a medical illness, they are subjugating them. They wish to offer “support” and services whose only purpose is to allow women to ignore their own needs and desires and focus on those of their children.

The Total Woman taught that women could find true happiness only by submitting to their husbands. The philosophy of the Natural Mother teaches that women can find true happiness by submitting to their children’s every need or desire, no matter how trivial. Although they may seem very different, they are fundamentally united: both are predicated on the belief that women’s role in the world is to serve others, never themselves.

To a hammer, everything looks like a nail. To a natural childbirth advocate, everything looks like an opportunity to push her agenda.

It was ugly when natural childbirth advocates expropriated the tragedy of maternal mortality among women of color — a tragedy largely rooted in socio-economic conditions — to claim, falsely, that these deaths reflect the failure of modern obstetrics. Their solution? Providing the natural childbirth services that privileged women want.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Jennifer Block’s recent piece on postpartum depression is cruel, deadly, self-serving bullshit![/pullquote]

Now it’s ugly when Jennifer Block and Alisa Alpert (a natural childbirth celebrity and doula respectively) are trying to expropriate the tragedy of postpartum depression — a tragedy of serious psychiatric illness — to claim, falsely, that it is the result of the pressures of capitalist societies. Their solution? You guessed it! Providing the natural childbirth and lactivist services that privileged women want.

Referring to the first ever approved drug for the treatment of postpartum depression, Block and Alpert write:

Postpartum depression is a serious problem, affecting, by some estimates, one in nine American mothers. It can be incredibly painful and is believed to be a growing cause of maternal deaths in the year following a birth. Insurers are expected to cover the exorbitant cost of Zulresso, which suggests that there’s finally a will to address our country’s dismal record on maternal health. Hurray!

But if we really want to tackle postpartum depression, we need more than a drug…

The clinical definition of postpartum depression is a “medical complication of childbirth,” but this doesn’t take into account women’s emotional lives, and the fact that the way our culture treats some new mothers amounts to abuse.

That, not to put too fine a point on it, is bullshit!

What is postpartum depression?

Postpartum depression (PPD), the onset of depressive episodes after childbirth, is the most common postnatal neuropsychiatric complication. Postpartum depression affects 10% to 20% of women after delivery, regardless of maternal age, race, parity, socioeconomic status, or level of education.

It is NOT the mild, self limited alteration in mood experienced by many women in the postpartum period:

Postpartum blues occurs in 50% to 80% of new mothers. Signs and symptoms appear within 1 to 2 days postpartum and include depressed mood, anxiety, tearfulness, irritability, poor appetite, and sleep problems. These changes are mild and resolve spontaneously within 10 to 14 days …

In contrast, symptoms of postpartum depression include: persistent depression, persistent loss of interest and pleasure in previous enjoyable activities, changes in appetite, changes in sleep, persistent fatigue, difficulty concentrating, feelings of worthlessness, thoughts of suicide.

In other words, postpartum depression is major clinical depression in the peripartum period.

It is critically important to understand that while any major depression, including postpartum depression, can be exacerbated by socio-economic problems, socio-economic problems do NOT cause major depression including postpartum depression. It is a MEDICAL ILLNESS with an ORGANIC cause, even if we don’t yet know the exact cause. As anyone who has ever loved or cared for a person with major depression learns, no amount of love and support can prevent it, treat it or cure it. Only therapy and medication can do that.

A drug that can treat postpartum depression specifically is a major medical breakthrough! I have no idea how well it works or whether it will work at all, but it marks an important milestone: a recognition that postpartum depression is a disease.

Not according to Block and Alpert:

Pregnant women are often pickled in horror stories about birth, then subjected to unnecessarily intrusive care. Many suffer pelvic trauma; one in three wind up with major abdominal surgery. Then they are sent home with a newborn, typically without support. According to 2015 data, a quarter of women return to work in two weeks. Everyone says that “breast is best,” but new mothers get a decent place to pump at work only if they’re lucky. Most won’t see their doctor again for six weeks. No wonder depression is so common.

As one mother we know who plans to quit her job (because she can afford to) said about the lack of parental support in this country: “It’s just so mean.”

A new expensive drug is not enough; we need humane, evidence-based maternity care, respect for the “fourth trimester,” months if not years of paid parental leave, and affordable child care.

Bullshit! Bullshit!! Bullshit!!!

Postpartum depression exists in every time, place and culture: those with high C-section rates and those without access to C-sections; those in which mothers return to economic employment and those where they are not allowed to work; those with high breastfeeding rates and those with low breastfeeding rates; those with easy access to doctors’ visits and those with no doctors; those with evidence based maternity care and those without; those that provide copious postpartum support and those with none; those that provide parental leave and those that don’t; those that provide affordable childcare and those that provide no childcare of any kind.

That’s because it is a MEDICAL ILLNESS with an ORGANIC cause, not a barometer of socio-economic conditions.

Block and Alpert write:

We’d be foolish to believe that any drug is the magic fix that will once and for all end the metaphysical conundrum of experiencing fear, sadness, anger and despair during the most vulnerable time of our lives.

Bullshit! Postpartum depression is NOT a metaphysical conundrum any more than schizophrenia is.

If insurers are willing to throw down tens of thousands of dollars for a mother’s mental health, we can think of some alternatives that might have a better cost-benefit ratio: Six months paid leave. A live-in doula and a private sleep-training coach. Weekly massages and pelvic-floor rehab sessions. Relocation to a commune in the Bahamas.

Would they dare recommend six months paid leave, a live-in doula, weekly massage and a tropical vacation as a cure treatment for schizophrenia? I doubt it because they understand that schizophrenia is a serious psychiatric illness, not a manifestation of stress. Postpartum depression is a serious psychiatric illness, too, and pretending that a tropical vacation could prevent, treat or cure it is both flip and disrespectful.

In the meantime, we fear that Zulresso is just a stopgap, and yet another instance of pathologizing a very sane reaction to our very insane culture.

Bullshit! Cruel, deadly, self-serving bullshit!