Yesterday I wrote about Courtney Jung’s NYTimes op-ed Overselling Breastfeeding.

It’s a fabulous piece and has been shared widely on social media. It’s a frontal assault on the industry of lactivism, which profits by moralizing breastfeeding, grossly exaggerating its benefits, boosting the fragile self-esteem of some mothers at the expense of other mothers, and re-inscribing the privilege of white, relatively well off women by enshrining their parenting choices as normative.

Lactivists are very angry about it, which makes their feeble attempts to respond all the more remarkable.

[pullquote align=”right” color=”#f3ce01″]Stop denying that women feel shamed when you shame them![/pullquote]

It’s almost as if they are not listening to what is being said.

Consider the response from The Academy of Breastfeeding Medicine (ABM), the mouthpiece for professional lactivists. It’s entitled Promotion without Support: A Reply to Editorials that Attack Breastfeeding Advocacy by Casey Rosen-Carole, MD, MPH.

I like the title. It’s an explicit acknowledgement that is NOT breastfeeding that is being attacked but the zealous, industry backed efforts to promote breastfeeding. The title is the high point; it’s all downhill from there.

Rather, breastfeeding advocacy today focuses on the social conditions that prevent women around the world from being able to make choices that support their health and empowerment, and the futures of their babies.

That’s shockingly hypocritical. Breastfeeding advocacy focuses on forcing women to choose breastfeeding. There is some attention paid to issues like maternity leave, but the social conditions that are the focus of lactivist efforts are the creation of programs, public health messages and hospital policies that seek to shame women who choose not to breastfeed and to place as many impediments as possible in their way, such as locking up infant formula and forcing women to sign releases acknowledging the superiority of breastmilk before they can obtain formula.

The Orwellian named “Baby Friendly Hospital Initiative” is not friendly to babies and is nakedly cruel to mothers. It is not based on science; there’s no evidence for most of the tenets of the initiative, and the marginal impact is completely oversold.

I will not engage this discourse here, as it is clear from every medical expert panel in every country in the world that the benefits of breastfeeding for health of mother and baby, decreasing economic and health inequities, and supporting a healthy environment, are well established.

Expert medical panels can be and are often wrong, particularly when it comes to dietary recommendations. It is telling that Dr. Rosen-Carole flat out refuses to discuss the actual research (which shows the benefits of breastfeeding in first world countries to be trivial), replacing any evaluation of the scientific evidence with the incredibly paternalistic “just do what we tell you because we know better than you.” I’m not the least bit surprised that Dr. Rosen-Carole refused to discuss the evidence for the purported benefits of breastfeeding. It’s weak, conflicting, riddled with confounders and fails to support nearly every contention of the breastfeeding industry.

I am therefore saddened that media discourse on breastfeeding continues to undermine women by putting forth articles supporting the notion that a battleground exists between mothers…

The conflation of negative social experiences of mothers and breastfeeding advocacy is overstated.

That’s a classic example of “gaslighting,” named after the horror movie Gaslight.

According to Wikipedia:

Gaslighting … is a form of mental abuse in which information is twisted or spun, selectively omitted to favor the abuser, or false information is presented with the intent of making victims doubt their own memory, perception, and sanity. Instances [include] the denial by an abuser that previous abusive incidents ever occurred …

Are you a mother who feels like infant feeding has become a battleground where lactivists abuse other women? It’s all in your head.

When this cruelly dismissive attitude was pointed out to Rosen-Carole, she responded with a disingenuous addendum that continued with gaslighting tactic:

Let me be clear: No one is saying this isn’t happening to moms.

Actually, Dr. Rosen-Carole, YOU are saying it isn’t happening to moms. The language you use, referring to the battleground as a “notion,” leave little room for misinterpretation. Moreover, it implicitly calls the reliability and truthfulness of formula feeding mothers into question. They feel it is a battleground where they are being attacked. Who are you to tell them that they are wrong about their own feelings?

And don’t blame the media.

[The media] are too busy with articles that radicalize breastfeeding advocates and dispute the value of breastfeeding.

That’s a tactic that is beloved of political extremists and shouldn’t be used by medical societies. But lactivists are extremists, too, clinging to cherished beliefs in the face of a growing mountain of scientific evidence that undermines those beliefs. When questioned about their claims, lactivists point fingers at everyone else instead of addressing the criticism.

Rosen-Carole concludes with a flourish of shaming:

…[W]e are saving our justified anger for the development of much-needed policies, medical practices and community movements that support women to have the real possibility of making choices that support the health and well-being of their families. The social and media conversation needs to move on as well. Editorials like Jung’s in the ‘Times’ only serve to continue the false conflation of advocacy and social blaming, and the false battleground between mothers.

Making “choices that support the health and well-being of their families.” So formula feeding moms don’t support the health and well-being of families?

Choices? What choice besides breastfeeding is considered acceptable to professional lactivists.

The “false conflation of advocacy and social blaming”?

Let me make this as clear as I can for the folks at The Academy of Breastfeeding Medicine. It’s time for them to listen:

Stop denying that women feel attacked when you attack them!

Stop denying that women feel shamed when you shame them!

Stop pretending that their feelings don’t reflect the reality that you have created with your endless hectoring, exaggeration and moralizing!

Jung made some strong empirical claims. Address those claims. Examine your cherished beliefs and adjust them based on the scientific evidence. That’s what physicians and scientists are supposed to do; not retreat into denial and defensiveness.

Kudos to Courtney Jung for a fabulous NYTimes op-ed piece, Overselling Breastfeeding.

It’s not surprising that I love the piece. I’ve been saying exactly the same things for years.

According to Jung:

Oddly, the fervor of breast-feeding advocacy has ramped up even as medical research — published in The Journal of the American Medical Association, BMJ in Britain and The American Journal of Clinical Nutrition — has begun to report that the effects of breast-feeding are probably “modest.”…

Why so much pressure to moralize and promote breastfeeding? Because breastfeeding is an industry.

[pullquote align=”right” color=”” ]What could possibly be more lucrative for an industry than marketing its products as a moral imperative?[/pullquote]

…[T]he contemporary obsession with breast milk is also driven in part by big business — including the companies that manufacture breast pumps, the companies that make breast-milk-based nutritional supplements, and the companies that sell breast-feeding accessories. The A.C.A. regulation requiring insurance to cover the cost of breast pumps hands breast-pump manufacturers a substantial subsidy. Market analysts predicted that this regulation alone would expand the breast-pump market by more than 50 percent, to almost $1 billion a year in the United States alone, by 2020.

And that doesn’t even count the lactation consultant industry.

But breastfeeding is not the only thing being oversold for the benefit of the industry that profits from it. The philosophy of natural childbirth (vaginal birth without pain relief) is also being oversold and that industry is much larger and more lucrative. My book, Push Back: Guilt in the Age of Natural Parenting, available in early April 2016, encompasses not just the breastfeeding industry, but also the natural childbirth industry (and the attachment parenting industry).

The natural childbirth industry embraces midwives, doulas and childbirth educators. It includes books, movies and Hypnobirthing tapes. It is aggressively marketed by everything from blogs that sell ads to large lobbying organizations like The Childbirth Connection. And it represents billions of dollars in profits.

As Jung notes in regard to the breastfeeding industry, people often confuse “industry” for “corporations.” The same thing happens regarding the natural childbirth industry. True, midwives, doulas and childbirth educators don’t make millions of dollars each, but for many of them, natural childbirth represents 100% of their income. That’s in dramatic contrast to obstetrician-gynecologists who may derive the bulk of their income from gynecologic surgery and the majority of whose patients have no interest in the philosophy of natural childbirth. It’s hardly surprising then that the purveyors of natural childbirth services, books and products are very motivated to promote the philosophy.

Though natural childbirth is marketed as safer, healthier and superior to birth with technology, there’s no scientific evidence and there has never been any scientific evidence to support those claims. But when it comes to marketing brilliance, the natural childbirth industry is second to none. Indeed, their marketing tactics are so seductive that many people who would have no trouble recognizing conventional marketing are chastened and distressed when they realize they’ve fallen for the marketing tropes deployed by natural childbirth organizations, celebrity natural childbirth advocates and by the legions of lay women who have been taught to proselytize the beliefs of the faithful.

Jung doesn’t merely echo what I have been writing about the industry of breastfeeding, but she also advances the same claims that I have made about the roles of privilege and race in both the breastfeeding and natural childbirth industries (Breastfeeding: how privileged women make privileged choices normative and Managing the birthing body: how privileged women have made childbirth a project).

The effect of the moral fervor surrounding breast-feeding goes beyond mere shaming. It also reflects, and reinforces, the divisions of race and class that have long characterized American social life. Although 91 percent of women in the top income quintile breast-feed, 71 percent of those below the poverty line initiate breast-feeding. Whereas 81 percent of white women breast-feed, 62 percent of black women do. Breast-feeding is a lifestyle choice the majority now make, but it is more common among white middle- and upper-middle-class parents.

In other words, the breast-feeding imperative has elevated the parenting habits of that relatively privileged minority to a universal standard of good parenting…

The philosophy of natural childbirth rests even more firmly on privilege. Nothing denotes privilege more emphatically than ostentatiously refusing something that those less privileged wish to have. In a world where millions of women, past and present, desperately beg(ged) for pain relief in labor, there’s no better way to communicate the unbelievable wealth, ease and self absorption of modern American life than elevating the refusal of easily available pain relief in labor to an “achievement.”

Follow the money. Both breastfeeding and natural childbirth are industries. What could possibly be better, or more lucrative for an industry than (falsely) marketing its products and services as moral imperatives?

To hear natural childbirth advocates tell it, vaginal birth is an unalloyed good.

The truth is rather different. Normal vaginal birth can lead to a lifetime of serious, embarrassing and life altering problems. Incontinence, among other issues, is an entirely natural consequence of an entirely natural vaginal birth.

As a newspaper piece from New Zealand notes, We need to speak more honestly about traumatic births:

[pullquote align=”right” color=””]Incontinence is an entirely natural consequence of an entirely natural vaginal birth.[/pullquote]

It ruins sex lives and destroys marriages, stops women from engaging in physical activities and even prevents some types of paid work. Although common, many women are so embarrassed by it that even their partners and closest friends are unaware of the problem.

It’s the injury that can result from a vaginal birth.

New research presented last week at the International Continence Society in Montreal about the psychological consequences of traumatic vaginal birth suggests that between 20 and 30 per cent of first-time mothers having a vaginal birth will suffer severe and often permanent damage to their pelvic floor and anal sphincter muscles. There can also be major psychological consequences of traumatic vaginal birth.

Conditions range from life-long urinary and faecal incontinence, painful sex, genital prolapse, body image problems and emotional trauma.

To understand why these problems develop we need to understand how the pelvic organs are held in place.

Ever wonder why the uterus doesn’t fall down through the vagina? It’s partly because of ligaments that hold it in place in the pelvis, but it’s mostly because of the muscles of the pelvic floor that form a sling to hold the organs up.

Here’s a classic view of the of the female pelvic floor seen in many anatomy textbooks:

The view is from the top down with the spine at the back (bottom) of the image, the pubic bone in the front (top) and all the organs have been removed.

You can see how the multiple muscles of the pelvic floor form a sling and that sling perforated by three tubes, at the top is the urethra, which carries urine from the bladder to the outside, the middle tube is the vagina, and the tube underneath is the rectum.

Now imagine a baby’s head, 10 centimeters in diameter, passing through this sling. It’s obvious that the fetal head is going to dramatically stretch, distort and possibly tear the muscles that surround the vagina. They will literally never be the same again. Where once the space between the muscles of the pelvic floor was only large enough to accommodate three relatively small tubes, now that space has been stretched tremendously.

Keep in mind that we are talking about internal muscles, not the tears in the vagina that occur externally (1st, 2nd, 3rd and 4th degree tears). External tears produce visible external damage. It’s not difficult to understand that a 3rd degree tear (a tear through the sphincter muscle surrounding the anus, which is locate below the level of the pelvic floor) makes continence of flatus (gas) and stool impossible. The anal sphincter is under voluntary control, but if it is torn, the anus cannot be closed to the prevent the release of the contents of the rectum. Stitch the sphincter muscle back together again and continence will be restored.

Injuries to the muscles of the pelvic floor take place at a deeper level, not visible externally, and not accessible to repair. The most common injury to these muscles is stretching and kegel exercises are designed to strengthen the muscles and thereby tighten them. But the injuries can be more severe than stretching. The muscles themselves can be torn away from the pelvic bones.

Midwife and co-author of the new research into psychological consequences of traumatic vaginal birth Elizabeth Skinner spent two years gathering and analysing the experiences of women who have suffered traumatic vaginal births.

“Women who have sustained vaginal birth trauma often have avulsion of the levator ani muscle. This is a disconnection of that muscle from the pelvic bone resulting in prolapsed organs. Women just put up with this “hidden injury” as they are too embarrassed to discuss symptoms with clinicians who frequently do not believe them,” Skinner says.

No amount of kegel exercises can repair pelvic muscles that are torn. When these muscles are torn, the pelvic organs can slip through the middle of the pelvic floor. This is known as prolapse. When a pelvic organ like the bladder prolapses, it distorts the relationship between the sphincter that controls release of urine from the bladder into the urethra. Although the sphincter itself has not been damaged, it nonetheless prevents the woman from “holding” urine. It works well enough that urine doesn’t constantly dribble out of the urethra, but when the intra-abdominal pressure is dramatically increased as occurs during coughing and sneezing, urine squirts out (stress urinary incontinence).

The damage may not be immediately apparent. It may not appear until menopause when ligaments are weakened by the lack of estrogen and the pelvic organs begin to drop between the muscles. A woman who has had no problem for 20+ years after the births of her children may gradually develop uterine prolapse and/or incontinence as she enters menopause.

How often does damage to the pelvic floor occur?

Professor of Obstetrics & Gynaecology, at the University of Sydney’s Medical School Hans Peter Dietz says that damage from vaginal birth is much more widespread than generally assumed.

“Only about 25 per cent of women get a non-traumatic normal vaginal delivery that did not do serious damage to their pelvic floor or their anal sphincter’, says Professor Dietz. ‘And this is on first time mothers. If we did this kind of analysis on women who try for a VBAC (vaginal birth after Caesarean) it would probably be as few as 10 to 15 per cent.”

In other words, up to 75% of women who have a vaginal birth will end up with some permanent damage to the muscles. The likelihood of damage rises dramatically with the use of forceps for obvious reasons. Putting forceps into the vagina and around the baby’s head creates a larger diameter than the baby’s head alone.

In our efforts to reduce the C-section rate, we’ve made the problem worse.

The policy to reduce caesarean births has lead to an increase in the use of forceps during vaginal deliveries and a tolerance for longer periods of pushing during the second stage of labour, both of which increase the risks to the mother and baby.

“The forceps rate has doubled in NSW over the last 10 years. At some hospitals quadrupled,” says the University of Sydney’s Professor Dietz. ‘That means much, much more damage is done than ten years ago — in some instances twice as much. This is largely a result of the attempt to reduce the caesarean births rate.”

One way to completely prevent damage to the pelvic floor is to have a C-section on maternal request.

Elizabeth Skinner and Professor Dietz are not against vaginal births; in some cases a vaginal birth is the best option. They also note that a caesarean section is major abdominal surgery and carries its own risks.

However women who have big babies, are short in stature, have Asian heritage, and have a family history of difficult births should be informed of their greater risk of trauma if they have a vaginal birth. And all women should be given the choice to make an informed decision for themselves.

Urinary and fecal incontinence, uterine prolapse and painful sex are not trivial problems. They can be life altering and the are the entirely normal consequences of completely normal vaginal birth. It’s hardly surprising that many women want to avoid them and it’s deeply unfortunate that in a society where vaginal birth is valued more than C-sections, no one warns women that they can occur.

What could be more deeply spiritual, personally empowering and beautiful than being born head first into a fecally contaminated toilet?

According to the mother’s Facebook post:

Ooommmmggggg!!

I dropped him in the toilet lol id like idk what to dooooo!!!!!!

I love him so much!! Still hasnt hit me yet!!

He’s the chillest baby every BTW!!

Ha, ha, ha, ha. She had a deliberately unassisted homebirth and dropped the baby on its head into the toilet. So funny! NOT.

[pullquote align=”right” color=””]Ha, ha, ha, ha. She had a deliberately unassisted homebirth and dropped the baby on its head into the toilet. So funny! NOT.[/pullquote]

What could be better than that? Apparently having your partner video it instead of catching the baby (always thinking of bragging rights!) and then immediately posting it on Facebook to get kudos from the other narcissists for your stupid, immature stunt.

“I love him so much!!”

Just not so much that she would actually protect his health and life by giving birth in the hospital. Her birth experience is ever so much more important than a baby with a mouth full of feces.

Amazingly, 310 other selfish idiots thought that the post was so beautiful that they liked it.

But now these buffoons from the unassisted birth Facebook group are angry.

No, not that the baby was treated literally like shit. Be serious! They don’t care about that.

They’re angry that I posted it on The Skeptical OB Facebook page.

The comments are priceless!

It was an accident?

No, it wasn’t. She chose to give birth on the toilet and her partner chose to record it instead of catching the baby.

I’m “judgemental”? Damn straight!

It’s beautiful? Only if you think the important part of birth is bragging to your friends regardless of what happens to the baby.

The parachuters proceeded to embarrass themselves by bleating the usual homebirth garbage …

… but were unable to back it up with any scientific evidence of any kind.

No problem!

As Dietra explains, whether homebirth is safe or not “has nothing to do with facts.”

Sorry Dietra, but it has everything to do with facts.

It’s a FACT that homebirth increases the risk of perinatal death up to 800%.

It’s a FACT that there is no evidence that homebirth in the US is safe.

It’s a FACT that there is no evidence that unassisted birth is ever safe.

But, hey, what are facts compared to a mother’s right to risk her baby’s death for kudos from her Facebook friends? What are facts when compared to a mother’s right to drop her baby head first into a fecally contaminated toilet? What are facts compared to a mother’s desperate need to boost her fragile self esteem with a selfish, immature narcissistic stunt like homebirth?

It’s hardly surprisingly that in a world where dropping your baby onto its head in the toilet is considered “beautiful” facts make no difference at all.

The natural childbirth movement has unveiled a new motto:

Safety Third!

No, not really, but they might as well have made it their motto.

Yesterday I wrote about midwife Hannah Dahlen and her various cold blooded statements about perinatal death, especially:

[pullquote align=”right” color=”#c89f1e”]To hear many midwives and natural childbirth advocates tell it, the first and most important priority is the mother’s birth experience.[/pullquote]

When health professionals, and in particular obstetricians, talk about safety in relation to homebirth, they usually are referring to perinatal mortality. While the birth of a live baby is of course a priority, perinatal mortality is in fact a very limited view of safety.

A reader, Houston Mom, jokingly described Dahlen’s approach as “Safety Third!” and the more I thought about it, the more apt it seemed as a motto for the entire natural childbirth movement.

Experience First!

To hear many midwives and natural childbirth advocates tell it, the first and most important priority is the mother’s birth experience.

As Caroline Bledsoe and Rachel Scherrer note in The Dialectics of Disruption: Paradoxes of Nature and Professionalism in Contemporary American Childbearing:

… As childbearing became safer and more benign visions of nature arose, undesired outcomes of birth for women came to consist of a bad experience and psychological damage from missed bonding opportunities. Today, with safety taken for granted, the new goal has become in some sense the process itself: the experience of childbirth… (my emphasis)

Specifically:

If nature is defined as whatever obstetricians do not do, then the degree to which a birth can be called natural is inversely proportional to the degree to which an obstetrician appears to play a role. The answer to why obstetricians are described with such antipathy thus lies not in the substance of what obstetricians do that is unnatural … but in the fact that obstetricians represent a woman’s loss of control over the birth event…

Many midwives and natural childbirth advocates certainly believe this to be so. Dahlen is shockingly explicit about this belief:

Women have told us there is something worse than death – there is being alive but dead inside. There is being so traumatised by pressurised interventions in their birth plan that … their own mental health is affected.

Worse than death??!!

Ask any woman whose baby has actually died and you will find that there are vanishingly few women who believe that there is something worse than the death of their babies. Dahlen’s claim doesn’t reflect reality, merely the central conceit of those in the natural childbirth industry.

Providers’ Experience Second!

The providers’ experience is dramatically more important in the midwifery/natural childbirth paradigm than in obstetrics. Even a brief look at the midwifery literature confirms the central role of the midwife’s experience. Several years ago I did an informal analysis of the papers in various midwifery and obstetric journals. I found that anywhere from 20%-50% of papers in midwifery journals are concerned specifically with the midwife’s experience, whereas only 0%-8% of papers in obstetric journals mention the obstetrician’s experience.

For many midwives, process is deemed more important than outcome and the ideal process is one that affords the midwife maximum scope for practice and profit. Natural childbirth has come to be defined as “anything a midwife can do” regardless of whether it happens in nature or not.

A rather bizarre confirmation of the centrality of the provider experience among natural childbirth advocates is the existence of counterfeit midwives who have awarded themselves the designation “certified professional midwife” or CPM. These women are laypeople whose only education requirement is a high school diploma, and they fail to meet the minimum international standards for midwives. Not only are these counterfeit midwives allowed to practice in nearly half of all US states, the organizations that certify and represent them have NO safety standards of any kind. Safety is simply not a priority for CPMs.

The other confirmation of the centrality of the “provider” experience is the importance of the payor experience. The British National Health Service is desperately promoting homebirth despite the fact that it is not safe for a substantial proportion of women and despite the fact that 95+% of women have absolutely no interest in delivering far from medical expertise or pain relief. No matter. The ability of the payor to save money (even if those savings are subsequently dwarfed by massive monetary payouts for injured and dead babies) is considered more important than what women actually want or what is safest for babies.

Safety Third!

These factors relegate safety to third position in the hierarchy of natural childbirth values.

Partly it’s because natural childbirth advocates are profoundly ignorant of the medical and historical realities of childbirth. Childbirth is and has always been, in every time place and culture, a leading cause of death of young women and THE leading cause of death of babies. Childbirth in industrialized countries in 2015 appears safe, but only because of the liberal use of obstetric interventions. Without them, childbirth is inherently dangerous.

Mostly, though, it is because many midwives and natural childbirth advocates actually believe that both the maternal experience and the provider experience is more important than whether a baby lives or dies. Not surprisingly, in cultures like UK midwifery where this ugly philosophy is allowed free rein, there are a never ending series of scandals involving preventable perinatal and maternal deaths followed by midwives’ attempts to cover them up.

Modern obstetrics is not perfect. No one knows that better than an obstetrician like me. But at least obstetricians have their priorities in order. Safety of mother and baby comes first. Period. That’s why female obstetricians choose liberal use of obstetric interventions for themselves and their babies. That’s what is safest.

The truth is that safety ought to come first. That doesn’t mean that the mother’s experience is irrelevant; just that it is not as important as her safety and the safety of her baby unless she explicitly claims that her experience is more important to her than whether the baby lives or dies. The providers’ experience ought to be irrelevant. The preferences of midwives ought to be no more important in the provision of childbirth care than the preferences of neurosurgeons in the provision of brain surgery. Making midwives’ experiences equal to or more important than safety is, in my view, grossly unethical.

Ultimately, it is up to individual women to decide what is important to them. If you prioritize safety (and the vast majority of women do), then safety takes precedence. Before choosing providers, you should understand for many midwives though it’s “Safety Third.”

She’s back!

Midwife Hannah Dahlen is once again trying to set straight those of us who prefer to deliver live babies instead of dead ones.

You may remember Dr. Dahlen as the author of the heartless claim:

When health professionals, and in particular obstetricians, talk about safety in relation to homebirth, they usually are referring to perinatal mortality. While the birth of a live baby is of course a priority, perinatal mortality is in fact a very limited view of safety.

[pullquote align=”right” color=”#497a1a”]Why do natural childbirth advocates require specific conditions to bond with their babies, while the rest of us love them unconditionally merely because they are ours?[/pullquote]

It’s not simply a priority. Protecting the life of both baby and mother is the sine qua non of competent childbirth care.

Dahlen is also a hypocrite, publicly wailing about toxic postnatal experiences while she and her colleagues promote the conditions that lead to toxic postnatal experiences.

Women have told us there is something worse than death – there is being alive but dead inside. There is being so traumatised by pressurised interventions in their birth plan that they can’t care for their newborn or have a relationship with their partner, and their own mental health is affected.

That’s like the fashion industry bemoaning negative body image. Pious concern for women’s feelings is difficult to take seriously when it comes from the very people who make women feel bad about themselves. In the case of the fashion industry, idealized representations of the female body lead to self hatred when women’s bodies don’t meet the fashion industry norm. In the case of the natural childbirth industry, idealized representations of birth lead to self hatred when women’s birth experiences don’t meet the natural childbirth industry norm.

For example, in a recent piece for The Conversation on vaginal birth after Cesarean (VBAC), Dahlen made a claim that is both cruel and outrageous.

The advantages of a VBAC include … enhanced mother-infant bonding.

There is no scientific evidence for that claim; it is precisely the kind of gratuitously cruel remark that leads women to hate themselves when their birth experiences don’t meet the natural childbirth industry norm, something that Dahlen supposedly deplores.

Perhaps Dr. Dahlen can explain to us how a dead baby affects the mother-infant bond.

The primary reason for repeat C-section is to avoid the risk of uterine rupture and perinatal death. Women who choose repeat C-section often do so because they’d rather carry the risk of surgery rather than foisting the risk of uterine rupture and death on the baby. Yes, the absolute risk that the baby will die from an attempted VBAC is small, but it is real and it WILL happen to some babies. Faced with the small, but real risk of the baby’s death, many mothers will opt for abdominal surgery with the pain, potentially harder recovery and increased risk of infection or bleeding. In other words, women who choose repeat C-section want to protect their babies from any risk, no matter how small, at the cost of pain and potential suffering to themselves.

It seems to me that mothers who choose repeat C-section for that reason have already bonded with their baby in utero.

Midwives like Dr. Dahlen fail to grasp one of the most important things that any pregnant woman could tell her: women bond to their babies before birth and don’t need a specific birth experience to create that bond.

I’ve always loved this quote from Maureen Hawkins:

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

It beautifully describes how fiercely I bonded to each of my four children, even before they were born. I had no control over it. It happened without my doing a single thing.

The idea that a vaginal birth is required for a mother to bond to her baby, or enhances the bonding process, is an utter lie.

That’s not to say that every woman bonds to every baby immediately. It can take days or weeks or more, but nearly every woman manages to bond fiercely to her child and nearly every child bonds fiercly to his or her mother.

Perhaps Dr. Dahlen can explain this to us as well:

Why do natural childbirth advocates like Dr. Dahlen seem to require specific conditions in order to bond with their babies, while the rest of us love them unconditionally merely because they are ours?

For thousands of years it occurred in the comfort of one’s own home, surrounded by cherished family members and employing principles of ancient wisdom. I’m talking, of course, about ancient brain surgery, known as trephination.

Primitive cranial trephining, the surgical opening of the skull performed with primitive tools and techniques, is one of the most fascinating surgical practices in human history. It probably started in the Neolithic at least 7000 years ago.

Remarkably, it is performed yet today in parts of Africa, South America, and Melanesia.

That’s why it makes perfect sense for the NHS to take pressure off hospitals by encouraging home brain surgery.

[pullquote align=”right” color=”#333333″]There’s an unholy alliance between the NHS, desperate to save money regardless of who dies as a result, and the Royal College of Midwives, desperate to increase autonomy regardless of who dies as a result.[/pullquote]

Wait, what? The NHS is not encouraging home brain surgery? It’s not encouraging it because too many lives, including men’s lives, would be put at risk by brain surgery at home even though that’s how brain surgery was done for most of human history?

Oh, right, the NHS plans to “take pressure off hospitals” by encouraging home birth! That way the only people who will die are women and babies. That makes much more sense and is in keeping with the long time practice of the NHS to save money on the backs and through the agony of women.

According to The Daily Mail:

Officials want to encourage expectant mothers to have their babies outside hospital, either in small, midwife-led units or their own homes.

One proposal under consideration would see women offered vouchers to pay for their own private midwife for a home birth, if it could not be arranged on the NHS.

It has been put forward as part of a major review of maternity services being overseen by NHS England which is expected to report back next year.

Officials want to drive up safety and improve the overall birthing experience amid concerns that some labour wards are very understaffed.

Apparently officials of the NHS feel that it is too expensive to let UK midwives kills babies in hospitals when they could kill them cheaply at home.

1. At Morecambe Bay:

Frontline staff were responsible for “inappropriate and unsafe care” and the response to potentially fatal incidents by the trust hierarchy was “grossly deficient, with repeated failure to investigate properly and learn lessons”.

Kirkup [the author of the report] said this “lethal mix” of factors had led to 20 instances of significant or major failures of care at Furness general hospital, associated with three maternal deaths and the deaths of 16 babies at or shortly after birth.

“Different clinical care in these cases would have been expected to prevent the outcome in one maternal death and the deaths of 11 babies.

Indeed:

The midwives at Furness general were so cavalier they became known as “the musketeers”.

Of note, officials at Morecambe Bay attempted to short circuit investigations of the deaths and only relentless pressure by parents of babies who died ultimately led to an investigation.

2. At Royal Oldham/Greater Manchester, 7 babies and 3 mothers died in the space of 8 months:

Seven babies and three mums have died in two Greater Manchester maternity units in the space of just eight months – sparking an independent investigation.

Bosses at Royal Oldham and North Manchester General Hospitals called in outside experts to review the departments in light of the 10 tragedies …

It is understood the deaths took place between December 2013 and July last year – with four babies and two mums dying at Oldham, and three babies and one mother dying at North Manchester.

Once again, the hospitals themselves failed to investigate the deaths until a midwife anonymously reported them to the newspaper:

One Royal Oldham Hospital midwife, who contacted us anonymously … said: “It’s worse here than Morecambe Bay. It’s really bad, there have been lots of problems. Babies have died unnecessarily.”

3. At Milton Keynes:

History is repeating itself with the deaths of FIVE more newborn babies following staff failures at the hospital maternity unit…

Milton Keynes has now seen at least eight such deaths in two separate periods over the last eight years.

The latest five deaths happened over eight months between 2013 and 2014…

Most of the deaths involved staff failing to recognise or act upon warning signs of foetal distress.

All the babies were full term and previously healthy, and in each case parents claim speedier medical intervention could have saved their lives.

This is the second spate of preventable perinatal deaths:

Between 2007 and 2010 three babies had died due to midwife and doctor failures – a situation slammed as “scandalous” by coroner Tom Osborne .

As a result a CQC task force was put into the unit for a year. But in July 2013 problems recurred when staff failed to act after an unborn baby girl developed an abnormal heartbeat during labour.

The child was born with asphyxia and died two days later.

In November the same year two baby boys died shortly after they were born 24 days apart. Once again, vital clues from their deteriorating heartbeats during labour had been ignored for too long.

In all three cases the hospital admitted liability and offered a settlement – of around £20,000. The parents all refused and are now launching legal action.

Two more babies died between November 2013 and March 2014. In each case the hospital has admitted the care was “not good enough.”.

Meanwhile there is a sixth case, involving a baby boy born in January this year. An inquest will shortly decide whether failures by the hospital contributed to his death.

That’s dozens of preventable perinatal and maternal deaths in just 3 hospital systems. It may be only the tip of the iceberg.

Why has this happened?

I suspect it is because of an unholy alliance between the NHS, which is desperate to save money regardless of who dies as a result, and the Royal College of Midwives, which is desperate to increase its autonomy regardless of who dies as a result.

And I am sad to say, it reeks of gender discrimination. The NHS is trying to save money on the backs of women. They are willing to deprive them of state of the art obstetric care by replacing obstetricians with midwives, by allowing midwives to practice without appropriate oversight, and, in promoting homebirth, by letting them practice with no oversight at all.

I haven’t seen the NHS propose outsourcing to the home of any aspect of male medical care. How about home prostatectomies, or home vasectomies? Each of those procedures is far less dangerous, and far less painful than childbirth … but those procedures involve men, and apparently, the NHS believes that they shouldn’t save money by letting men suffer.

You have to credit the NHS with one achievement, though. In a masterpiece of marketing the NHS plans to take life saving services away from women and babies and pretend that allowing preventable deaths is improving “choice.” The fact is that more than 95% of women DON’T want to give birth at home. They’ve had the option for many years and they’ve rejected it.

But women, their needs, their desires, their very lives, pale when weighed against the NHS desire to save money and the RCM desire to increase autonomy.

The only issue going forward is how many babies and women are going to die as a result.

The journal Nature published an outstanding piece on one of the most serious problems in scientific research today: a great deal of research is so flawed that it cannot be reproduced. It’s a problem that strikes at the heart of science, since the gold standard for establishing the truth of research results is that other scientists using the same methods will find the same results. Irreproducible research is research that is worthless; it proves nothing and often misleads.

How scientists fool themselves – and how they can stop by Regina Nuzzo offers a comprehensive explanation of why so much of today’s research is not reproducible: simply put, scientists have a great personal stake in the outcome of research, and this personal bias leads to shoddy science.

[pullquote align=”right” color=”” class=”” cite=”” link=””]The bias is simple, pervasive and distorts a great deal of breastfeeding research.[/pullquote]

This personal bias differs in important ways from classic financial conflicts of interest. No money changes hands; there is no quid pro quo, and there are no university or journal rules to protect against such personal bias. Indeed, the researchers themselves are often unaware of the bias because is subconcious.

Breastfeeding research, though not mentioned in the piece, is a classic example of the personal bias that renders much of the reasearch in the field misleading and deceptive. Breastfeeding reseachers believe deeply and fervently that breastfeeding, being natural, must be better than any substitutes. Therefore, they slice and dice the data until it supports their bias. They fall prey to the errors that Nuzzo describes in her piece.

1. Hypothesis myopia:

One trap that awaits during the early stages of research is what might be called hypothesis myopia: investigators fixate on collecting evidence to support just one hypothesis; neglect to look for evidence against it; and fail to consider other explanations…

This probably the most serious problem in breastfeeding research and distorts most of the existing research that claims to show important health benefits. The conclusions are predetermined and the data are arranged to support the conclusion. Critically, the researchers fail to consider alternative explanations for observed outcomes. In the case of breastfeeding research, it is typically manifested as a failure to correct for confounding variables.

We know that women who choose to breastfeed exclusively differ in important ways from women who do not. Any “benefits” of breastfeeding may reflect those differences, not breastfeeding itself. For example, women who choose to breastfeed exclusively are, on average, wealthier, better educated, and have better access to health insurance. Each of these three variables have been shown to lead to improved health outcomes for their children. The alternative explanation for most of the research that purports to show major health benefits of breastfeeding is that those benefits aren’t caused by breastfeeding, but are the inevitable result of the relatively privileged status of the mothers.

2. The Texas sharpshooter fallacy:

Seizing on random patterns in the data and mistaking them for interesting findings.

This is also known as “p hacking”:

“You just get some encouragement from the data and then think, well, this is the path to go down,” says Pashler. “You don’t realize you had 27 different options and you picked the one that gave you the most agreeable or interesting results, and now you’re engaged in something that’s not at all an unbiased representation of the data.”

In 2012, a study of more than 2,000 US psychologists suggested how common p-hacking is. Half had selectively reported only studies that ‘worked’, 58% had peeked at the results and then decided whether to collect more data, 43% had decided to throw out data only after checking its impact on the p-value and 35% had reported unexpected findings as having been predicted from the start, a practice that psychologist Norbert Kerr of Michigan State University in East Lansing has called HARKing, or hypothesizing after results are known.

In the case of breastfeeding studies, researchers often analyze large datasets looking at multiple outcomes. Then they pick the outcomes that have statistically significant differences and announce them as “findings” without acknowledging that any large dataset looking at multiple outcomes is bound to have random statistically significant differences that are coincidental and don’t represent real outcomes.

3. Asymmetric attention:

The data-checking phase holds another trap: asymmetric attention to detail. Sometimes known as disconfirmation bias, this happens when we give expected results a relatively free pass, but we rigorously check non-intuitive results…

This happens all the time in breastfeeding research and especially in its analysis. Professional breastfeeding advocates report findings on the benefits of breastfeeding without analyzing the data. In contrast, when a study is published that does not support a cherished tenet of lactivism, such as the belief that breastfeeding raises IQ, professional breastfeeding advocates immediately try to tear it apart.

How can we avoid falling prey to these cognitive biases?

The most important corrective to cognitive biases is recognizing that they exist. We must recognize that most scientists who do breastfeeding research believe that breastfeeding must be superior. They often fail to consider alternative explanations for their findings, but we don’t have to fall into the same trap. The first question to ask of any breastfeeding study is whether it accounted for confounding variables. If it didn’t, then the results are meaningless.

Second, we must analyze the data in the study ourselves to see if it justifies the conclusions. We need to ask whether the authors’ conclusions relate to the subject they intended to investigate or are just a random finding. For example, researchers may set out to determine if there is a difference in IQ between breastfed and non-breastfed babies, fail to find one and then write a paper about a random difference in fine motor coordination. That suggests p hacking, desperately searching for any difference, not the one that was supposed to be under study.

Finally, we must pay close attention to the results of studies that support our pre-existing biases. We must analyze them with the exact same rigor that we would bring to analyzing studies that don’t support what we believe.

Contemporary breastfeeding researchers often fool themselves into finding “benefits” of breastfeeding but that doesn’t mean that we have to let them fool us, too.

The new CDC report on breastfeeding, Improvements in Maternity Care Policies and Practices That Support Breastfeeding — United States, 2007–2013, has been getting a lot of press.

According to the report

…[P]ractices supportive of breastfeeding are improving nationally; however, more work is needed to ensure all women receive optimal breastfeeding support during the birth hospitalization.

Implications for Public Health Practice: Because of the documented benefits of breastfeeding to both mothers and children, and because experiences in the first hours and days after birth help determine later breastfeeding outcomes, improved hospital policies and practices could increase rates of breastfeeding nationwide, contributing to improved child health.

There just one serious problem: The documented benefts of breastfeeding in the US are trivial and there’s no evidence at all that experiences in the first hours and days after birth determine later breastfeeding outcomes.

[pullquote align=”right” color=”#555555″]US breastfeeding rates have no impact on child health.[/pullquote]

The authors of the report have made a very serious error that undergirds everything they have written. They’ve confused correlation for causation.

Simply put, breastfeeding in the US is associated with higher socio-economic status (higher income, greater education, better access to healthcare). Therefore, the fact that breastfed children have better health outcomes is more likely to be the result of higher socio-economic status (and there are reams of papers demonstrating this fact) than with breastfeeding (on which the evidence is weak, conflicting and plagued with confounders.)

Suppose I did a study comparing two groups of children to determine if breastfeeding increases children’s height. Imagine further that I found the children from Group A, which contains a high proportion of exclusively breastfed infants, turn out to be several inches taller at age 5 than the children from Group B, who never received breastmilk.

Did breastfeeding make the children in group A taller? We can’t say unless we have more information.

Now we can see that the mothers in group A are actually taller than the mothers in group B. It is likely genetics that made the children in group A taller, not breastmilk.

In the case of breastfeeding, the mothers in the US who breastfeed (group A) are more likely to be privileged than the mothers who don’t (group B). It is that privilege that makes their children healthier, not breastfeeding. Breastfeeding does not cause better health outcomes, both breastfeeding and better health outcomes are the result of privilege.

The same phenomenon applies to experiences in the first hours and days. Babies whose mothers are strongly committed to exclusive breastfeeding (group A) are going to have different experiences than babies whose mothers are not as committed (group B). The babies in group A are more likely to be breastfed within the first hour, for example, and are far less likely to receive supplementation with formula. Those experiences don’t cause an increase in breastfeeding rates, they reflect mothers’ commitment to breastfeeding which is the cause of differential rates of breastfeeding months later.

Why do the CDC researchers put the cart (the conclusions) before the horse? It’s probably because of white hat bias, the tendency to reach socially approved conclusions. In 2015, “everyone knows” that breastfeeding is good for babies so white hat bias leads breastfeeding researchers to ignore the privilege (greater income, greater education, better access to healthcare) that leads women to breastfeed and ascribe the benefits to breastfeeding itself.

It is this fundamental error that is responsible for a curious outcome of breastfeeding promotion. Despite millions of dollars spent promoting breastfeeding, and a dramatic rise in breastfeeding initiation, there has been no improvement in indicators of child wellbeing. There’s been no drop in infant mortality, no increase in life expectancy and no change in IQ. As far as I am aware, there is not a single return on our massive investment in breastfeeding promotion.

And that’s just what you would expect if researchers confused correlation for causation. Increasing breastfeeding rates won’t change indicators of child health because breastfeeding doesn’t lead to healthier babies; privilege does. We are literally wasting millions of dollars on promoting a practice that has a trivial impact on health, and feeling virtuous for doing so.

Don’t get me wrong. Breastfeeding is a good thing; I breastfed four children because I believed breastfeeding to be a good thing. But scientific evidence is far more important than feeling virtuous and the scientific evidence is pretty definitive: the benefits of breastfeeding in the US are trivial, and there’s no evidence at all that so called “baby-friendly” hospital practices have any impact on breastfeeding rates.

Let’s stop wasting money, not to mention stop pressuring women into making a choice with trivial benefits and stop judging hospitals by that choice. Breastfeeding rates have no impact on child health.

If anyone, including the CDC researchers, believe otherwise they must provide scientific evidence that breastfeeding impacts child health, not the wishful thinking of white hat bias that leads them to put the cart far before the horse.

Imagine that. The Southern Baptist Convention has higher qualifications for becoming a missionary than the Midwives Alliance of North America has for becoming a “midwife.”

According to Inquisitr:

Jill Duggar and Derick Dillard are rejected as missionaries by the Southern Baptist Convention (SBC) and the International Mission Board (IMB) for lack of qualifications…

What qualifications are needed to become a missionary?

[pullquote align=”right” color=””]Why are the requirements for a missionary more rigorous than the requirements for a CPM?[/pullquote]

To be a funded missionary of the SBC and IMB requires a bachelor’s degree from an accredited university and between 20 – 30 graduate hours of designated courses, such as: Biblical Studies, Theology, Church History, Missions, Evangelism, Discipleship, Preaching, Interpersonal Relationships, etc.

Although Derick Dillard has an undergraduate degree in accounting, he has never taken a college-level religion course and has no graduate credit hours. Jill Duggar has never been to college at all. To qualify as the spouse of a Baptist missionary, she must complete at least 12 college credit hours by taking these courses at an accredited college…

There’s no shortage of people able to meet these qualifications:

churches. The SBC employees over 4,800 missionaries and 300 new missionaries were added just this year.

In contrast, Duggar Dillard has never been to college at all, but that hasn’t stopped her for earning the CPM, certified professional midwife credential. As a I wrote recently, CPMs aren’t real midwives, they’re counterfeit midwives.

The CPM is not a medical credential and it is a testament to its effectiveness as a public relations ploy that most Americans don’t realize it is a counterfeit midwifery degree. It is not recognized by the UK, the Netherlands, Canada or Australia because it doesn’t meet the international standards for midwifery education and training. Indeed, the US is the only country in the industrialized world that has a second class of counterfeit midwives in addition to real midwives (certified nurse midwives).

Imagine that you couldn’t be bothered (or couldn’t handle) the necessary preparation but wanted to masquerade as a midwife anyway. You could simply take a correspondence course, attend a few dozen deliveries outside the hospital, pay money for an exam and voila: you are a CPM. Actually, you don’t even have to complete even those minimal requirements. You can simply submit a “portfolio” of births that you have attended, pay the money and take the exam, and voila, you too are a CPM.

Indeed, the educational requirements for the CPM were “strengthened” back in 2012 to mandate a high school diploma.

That raises an important question. Why are the requirements for becoming a teacher of religion far more rigorous than the requirements for a midwifery credential which involves life or death decisions?

The answer is that the Southern Baptist Convention has quality standards for missionaries. Merely wanting to be a missionary isn’t enough. In contrast, the Midwives Alliance of North America has no safety or quality standards for their pretend credential. Their avowed aim is to allow any woman who wants to deliver babies to call herself a “midwife” regardless of what education she does or does not have.

The ultimate irony is that while trusting God is not enough to call yourself a missionary, “trusting birth” is deemed to be adquate for calling yourself a “midwife.”