Dr. Neel Shah owes a lot of women an apology.

I wrote yesterday about Dr. Shah’s endorsement of homebirth, both for Time.com and in this post.

My rebuttal of Dr. Shah’s claims was simple; he appeared to be entirely unaware of the published literature on the dramatically increased death rate at American homebirth, and equally unaware that homebirth in the US is typically attended by a second, inferior class of midwife, one who does not meet the basic education and training standards in any other industrialized country. Inexplicably, he was endorsing homebirth in the pages of the New England Journal of Medicine when he hadn’t read the basic literature.

Apparently stung, Dr. Shah sent me this unsolicited Tweet:

[H]ospitals are not seatbelts; they are airbags that explode in your face 1 out of every 3 times you get in the car.

I find that to be a ridiculous analogy, issued in an attempt to undermine the measured argument that I made.

I wrote:

Hospital births are like seatbelts. Most of the time you won’t be in a car accident so you don’t need them; but when you need them, they save lives. Just like failing to buckle your child in on a drive to the store in unlikely to result in that child’s death, homebirth is unlikely to result in the death of a child. But over large populations riding in cars repeatedly, routinely buckling seatbelts saves thousands of lives. When it comes to homebirth, each mother must decide whether she is willing to tolerate the risk to her baby of dying at homebirth, a risk that is higher than the risk of the same baby dying in a car accident.

Apparently Dr. Shah is referring to the American C-section rate of 32%. Talk about hyperbole! He implies that 100% of C-sections are unnecessary, and are performed merely because the system is malfunctioning spectacularly. At a MINIMUM, fully half of those C-sections he derides are medically necessary and a substantial proportion are literally life saving. Yet Dr. Shah implies that obstetricians are performing C-sections for reasons that aren’t merely illegitimate, but are a travesty exploding in the face of unsuspecting mothers. Dr. Shah owes American obstetricians an apology for that insinuation.

But I’d like to address a different issue:

What message are we sending to women when we deride their C-sections as airbags that “explode in your face”?

We are sending the message that women who undergo C-sections for whatever reason (Dr. Shah didn’t exclude medically necessary C-sections) are damaged, defective, and have been hoodwinked by evil obstetricians. In other words, we imply that women who have had C-sections ought to be ashamed of them and of themselves.

That’s an ugly, unjustified and unjustifiable message. This endless demonization of C-sections has got to stop. It is incontrovertible that C-sections have saved more lives than nearly an other procedure in modern medicine.

Is the C-section rate too high?

As someone who had a 16% C-section rate when I practiced, I believe that it is. Not because there is anything wrong with C-sections, not because C-sections cost “too much” and certainly not because vaginal birth is somehow better, since it isn’t it. I believe that we can safely lower the C-section rate somewhat by promulgating clearer, stricter indications.

Nonetheless, I have the deepest admiration and respect for women who undergo C-sections. Consider C-sections for fetal distress. In 2015, the diagnosis of fetal distress is imperfect at best:

…We know that almost all babies who experience lack of oxygen during labor will give evidence of that on electronic fetal monitoring. In contrast, many babies who appear to be in distress may actually be fine. When a woman consents to a C-section for fetal distress, she is saying in essence: I don’t know whether my baby is truly experiencing oxygen deprivation, but I don’t want to take any chances. Cut me and help the baby; if I’m wrong, it’s a price I’m willing to pay to be sure that my baby is okay.

In other words, its a sign of devotion, not a sign of failure. And it is NEVER a sign that they are damaged, defective or have been hoodwinked.

Dr. Shah owes C-section mothers an apology. In an effort to express his displeasure with me, he callously insulted them.

Not to mention his analogy is weak, incorrect and yet another example of the unreflective demonization of C-sections so beloved of those who can’t perform them and those who don’t want to pay for them.

This is an expanded version of a piece I wrote for Time.com.

Dr. Neel Shah, Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School has written two pieces on the safety of homebirth. The first, A NICE Delivery — The Cross-Atlantic Divide over Treatment Intensity in Childbirth, appears in The New England Journal of Medicine; the second, Are hospitals the safest place for healthy women to have babies? An obstetrician thinks twice was published on The Conversation website.

Dr. Shah is also the Founder and Executive Director of nonprofit organization Costs of Care, Inc., which describes its mission as:

We believe that Americans can get their money back by trimming the fat out of medical bills – replacing or rejecting services that eat into our wallets without making us healthier.

The Problem: many medical bills are inflated with unnecessary care

So the real question being addressed in these pieces is not whether hospitals are the safest place to have a baby. There’s no question that they are. The real question that Dr. Shah appears to be asking is: Are homebirths safe enough that we can shunt pregnant women into lower cost homebirths in an effort to save money?

That’s a reasonable question to ask, but Dr. Shah’s answer is compromised by his failure to address two major issues, the existence of two different types of midwives in the US with wildly divergent perinatal deaths rates, and the growing body of literature that shows that homebirth in the US has a mortality rate anywhere from 3-9X higher than comparable risk hospital birth.

Here’s how Dr. Shah frames the issue in the NEJM piece:

For generations, both British and American mothers have assumed that the safest way to give birth is to spend many hours, if not days, in a hospital bed under the supervision of an obstetrician. Now, new guidelines are challenging these deeply held beliefs.

After completing an evidence-based review, the United Kingdom’s National Institute for Health and Care Excellence (NICE) concluded that healthy women with straightforward pregnancies are safer giving birth at home or in a midwife-led unit than in a hospital under the supervision of an obstetrician.1 Across the pond, eyebrows went up. The New York Times editorial board (and others) wondered, “Are midwives safer than doctors?”2 How can homes be safer than hospitals? And what implications will the British guidelines have for the United States?

Dr. Shah claims:

At its core, this debate is not about the superiority of midwives over doctors or hospitals over homes. It is about treatment intensity and when enough is enough.

However:

1. In contrast to the UK where there is only one type of midwife, highly educated and highly trained, in the US there are two types of midwives: certified nurse midwives (CNM), the best educated, best trained midwives in the world, and a second, inferior class of midwife, certified professional midwives (CPM), who lack the education and training of midwives in EVERY other industrialized country. Most US homebirths are attended by this second class of midwife, the bulk of whom have attained their credential by correspondence course (or no courses) and who have served an apprenticeship with another, equally poorly trained CPM. The mortality rates reflect this fact.

2. There is a large and growing body of research that demonstrates that homebirth with an American homebirth midwife has a death rate 3-9X higher than comparable risk hospital birth. Curiously Dr. Shah’s scant list of only 5 references, doesn’t include any of the many papers and datasets that demonstrate the wide gulf in outcomes between homebirth and hospital birth.

It’s not possible to review the entire scientific literature of homebirth death rates, but here are some highlights:

In March 2013, Oregon released an analysis of homebirth deaths prepared by Judith Rooks, CNM, MPH that showed that PLANNED homebirth with a LICENSED Oregon homebirth midwife had a death rate 800% higher than comparable risk hospital birth.

In June 2013, Grunebaum et al. demonstrated that homebirth increases the risk of a 5 minute Apgar score of zero by nearly 1000%.

In January of 2014, Wasden et al. demonstrated that the risk of anoxic brain injury is more than 18 times higher at homebirth than comparable risk hospital birth.

In January of 2014, the Midwives Alliance of North America published their landmark study (actually a non-representative survey of less than 30% of their members completed 5 years ago) claiming that homebirth is safe but ACTUALLY showing that homebirth increases the risk of perinatal death by 450%.

So Dr. Shah’s question, are hospitals the safest place to give birth, has been repeatedly asked and answered: In the US, hospital birth is incontrovertibly safer than homebirth.

The real question is whether homebirth is safe enough to contemplate encouraging it as a cost saving measure as they are doing in the UK.

The answer to that question is debatable, but we are lacking important information that would allow us to debate it.

Are out of hospital births really cheaper than hospital births? On the face of it, the fee for giving birth outside a hospital is much lower than the fee for giving birth inside a hospital. However, the cost of the actual birth is not the only cost. What is the cost of transport and how does that add up when more than 40% of first time mothers are transferred to the hospital and then incur hospital fees as well? The most critical component, and it is a massive component, of any cost analysis of homebirth is the cost of caring for a brain injured child who might have avoided the injury in the hospital. Each one of those children requires tens of thousands or hundreds of thousands of dollars of expenditure each year, and if the brain injury is permanent, he or she may incur millions of dollars of care over a lifetime. And don’t forget to factor in the millions of dollars that will be paid out in legal judgments for damaged or dead infants, as well as the increased cost of liability insurance to cover these claims. It is quite possible that over large populations hospital birth costs less than homebirth.

Is homebirth safe enough? That’s an individual decision that can only be made by individual mothers considering their own wants and needs. Hospital births are like seatbelts. Most of the time you won’t be in a car accident so you don’t need them; but when you need them, they save lives. Just like failing to buckle your child in on a drive to the store in unlikely to result in that child’s death, homebirth is unlikely to result in the death of a child. But over large populations riding in cars repeatedly, routinely buckling seatbelts saves thousands of lives. When it comes to homebirth, each mother must decide whether she is willing to tolerate the risk to her baby of dying at homebirth, a risk that is higher than the risk of the same baby dying in a car accident.

Dr. Shah concludes his NEJM piece:

As a U.S.-trained obstetrician, I have little doubt that the United States offers outstanding care for medically complicated pregnancies. But there are lessons to be learned from the British system. The majority of women with straightforward pregnancies may truly be better off in the United Kingdom.

That point is debatable, for a variety or reasons, but one thing is not debatable.

The majority of American women with straightforward pregnancies are far better off in hospitals and it is unfortunate that Dr. Shah did not share the scientific evidence that makes that clear.

On the face of it, there’s no reason why breastfeeding, which in industrialized countries has only trivial benefits, has become a public health cause celebre.

There are so many, many issues that have a much greater impact on child health that are being ignored, while breastfeeding advocacy benefits from millions of dollars of public and private funds, extensive public health campaigns, and redesign of hospital policies. We have public health campaigns against smoking because that costs millions of lives; we have public health campaigns to promote vaccination because vaccines save millions of lives; we have public health campaigns to promote breastfeeding … which has never been shown to save even a single term baby.

If you want to see how trivial the impact of breastfeeding is on public health you need only look at the impact of breastfeeding on infant mortality in the US during the 20th Century when breastfeeding rates fluctuated dramatically from a high of over 75% to a low of 25% and back up to 75%. Breastfeeding rates had ZERO impact on infant mortality.

While breastfeeding advocates breathlessly promote studies that show trivial benefits within tiny groups of carefully selected individuals, we’ve already done the largest public health experiment possible and it shows that breastfeeding is NOT a public health issue since it has no impact on public health.

How then can we explain a multimillion dollar effort to promote breastfeeding rates in the absence of public health benefits?

There are several reasons that I have detailed many times in the past.

1. The science of breastfeeding has been subverted. The truth is that the scientific literature on the benefits of breastfeeding is weak, conflicting and compromised by confounding variables.

2. Breastfeeding advocacy is a huge business. While individual professional breastfeeding advocates don’t make large sums of money, 100% of the income of lactation consultant derives from breastfeeding promotion, and 100% of the income of lactivist organizations like the Orwellian-named Baby Friendly Hospital Initiative comes from the more than $10,000 they charge each hospital for the privilege of being designated lactivist baby friendly.

3. Breastfeeding promotion, which has its modern incarnation in La Leche League as an effort to keep women in the home and out of the workforce, is a response to the profound social disclocation of women’s emancipation. The political right has retreated into religious fundamentalism and the political left has retreated into mindless worship of “nature.” Simply put, aggressive promotion of breastfeeding is deeply retrograde and anti-feminist.

There is a fourth reason:

Breastfeeding advocacy dovetails perfectly with our contemporary “blame the mother” culture.

Blaming the mother for how a child turns out is hardly new. For most of human history mothers were blamed if a child was not a desired son (even though it is actually the father who is responsible for a baby’s gender); congenital anomalies were blamed on a mother’s dreams and fears; and severe mental illness in a child was blamed on emotionally cold “refrigerator mothers,” while homosexuality was blamed on inappropriately close relationships between mothers and sons.

No matter what it is, if it is bad, it’s always the mother’s fault.

This fits in perfectly with a contemporary political culture that denies government any role in dealing with vast social inequality within the population. American society has shifted violently to the political right, which takes as axiomatic the belief that government cannot and should not have any role beyond national defense.

We could look at the deficiencies in health, educational level, and income of Americans at the lowest end of the socio-economic spectrum and seek to correct the structural inequities within our society. But that would require a strong, well funded central government, anathema to conservatives. How much easier, cheaper, and politically reassuring then to blame these differences on the mother and insist, without any evidence at all, that her children would be more successful if only she had breastfed.

As Phyllis Rippeyoung explained in a recent position paper, Governing Motherhood: Who Pays and Who Profits? published by the Canadian Centre for Policy Alternatives:

This individualizing of responsibility for child welfare has also been seen among breastfeeding proponents, as most explicitly illustrated in an editorial by Dr. Ruth Lawrence, a founder of the Academy of Breastfeeding Medicine. In her essay, “The Elimination of Poverty One Child at a Time,” she argues that breastfeeding is the panacea for health and cognitive inequalities between poor and non-poor children. She ends the piece by writing that breastfeeding may be the only gift that poor mothers have to offer their children.

… I have been unable to find any research assessing whether breastfeeding … will actually reduce either poverty or the consequences of growing up poor, one child at a time or otherwise. In research I have recently completed (Rippeyoung forthcoming), I assessed the relative impact of breastfeeding versus the family educational environment on reducing gaps in child verbal IQ between the poor, the near poor, and the non-poor … This research indicates that individual solutions to low test scores will not solve the problems of inequalities in school readiness.

It is hardly a coincidence that the women who are targets for shaming by breastfeeding advocates are more likely to be poor, non-white and under-educated. It’s so much easier (and cheaper, not to mention politically gratifying) to chastise these mothers for not breastfeeding than to address the terrible environments in which many are forced to raise their children.

The ugly truth is that money spent on breastfeeding advocacy benefits only the advocates and not mothers or children.

We should stop spending money on public health campaigns to promote breastfeeding, both inside and outside hospitals. Instead we should divert that wasted money to initiatives that we know will help ameliorate social inequities: better public school funding, easy access to doctors for all children, and debt forgiveness for student loans. But that presupposes a beneficial role for government.

It is ever so much easier (and delightfully satisfying) to simply blame the mother for not breastfeeding.

I know, I know; what was I thinking?

Here I am, a 56 year old woman, old enough to be a grandmother (hint to my married and engaged children!) and I violated the standards of Facebook by heading a post about lactation with a picture of …

[Stop reading now if you are easily offended. Cover your children’s eyes. Gather your strength]

… a lactating breast.

Oh, the horror! No wonder that I’ve been banned from Facebook for 24 hours. I should have realized that infants and children might have seen that picture and who can bear to think about the consequences of that.

The post in question was Babies are dying because breastfeeding advocates are lying written to highlight the small but rising death toll that has resulted from breastfeeding advocates lying about the benefits of breastmilk and demonizing formula, apparently a trivial problem in comparison with the serious problem of people being exposed (full frontal!) to lactating breasts.

You can view the picture here. Shocking, isn’t it?

I’ve changed the picture and I’ve appealed the ban, but I’m not particularly hopeful.

I realize that Facebook relies on algorithms to police it’s photos and I imagine that real nipples are verboten. Obviously we don’t want Facebook to become cluttered up with porn, but it does raise an interesting question: why is a female breast inevitably construed as pornography?

We have a real problem as a society if we say we want to encourage breastfeeding but then we turn around and ban all images of the female breast as inevitably pornographic. Which is it? Is breastfeeding a beautiful gift that a mother can give a child, or is it something so perverted that it must be hidden from children and everyone else?

Breasts are inherently sexual. I know that, but that’s not a bad thing. Sexual is not the same as pornographic and we should be mature enough as a society to realize that.

The original photo that got me banned from Facebook is here.

Breastfeeding has a death toll.

In itself that’s not surprising because breastfeeding is yet another aspect of reproduction and all animal reproduction, including human reproduction, has very high rates of wastage from miscarriage, death during childbirth and death in the early months of infancy. What’s surprising is that deaths from breastfeeding, which in industrialized countries had been reduced to zero with the advent of infant formula, have begun to rise again.

The scientific literature contains new and disturbing reports of infant deaths due to hypernatremic dehydration as a result of inadequate breast milk consumption, deaths from falling out of mothers’ hospital beds as a result of pressure to room-in to promote breastfeeding, and, most recently, reports of hyponatremia due to dilution of breastmilk with water. It’s only a matter of time before there are illnesses and deaths from contaminated breastmilk bought and traded on the internet.

Why are these babies dying? They’re dying because lactivists are lying, exaggerating the benefits of breastfeeding far, far beyond anything in the scientific literature. And they’re lying about non-existent “risks” of formula to the point that mothers are afraid to use it even when supplementing with formula is a matter of life and death.

The biggest lie and perhaps the one that has done the most damage is the claim that “breastmilk is the perfect food.” To understand why that claim is a lie we need to consider what characteristics a perfect food for infants would have.

Here are the 3 characteristics that a perfect infant food would have:

1. It should contains all the nutrients and other factors that an infant needs.

2. It must be available in sufficient quantity to promote vigorous growth of the infant.

3. The infant must be able to access it easily.

Any food that does not meet ALL THREE criteria cannot, under any circumstances, be a perfect food for that child. Breastmilk may be the perfect food for some infants, but it is highly imperfect for many others.

Lactivists routinely ignore critera 2 and 3, and babies die as a result. They get around the need for an adequate supply of milk with a claim that is manifestly a lie, the claim that all mothers produce enough milk. It’s pretty clear that up to 5% of mothers cannot produce enough breastmilk to fully meet a baby’s needs. That’s hardly surprising since no biological process is guaranteed to work perfectly. If established pregnancies can have a 20% miscarriage rate, and they do, it is hardly surprising that breastfeeding can have a failure rate of only a fraction of that amount.

Lactivists get around the third criterion with another lie, that every baby is capable of efficiently extracting milk from the breast. Some babies just can’t do it for anatomical reasons, because of weak muscle tone, or because they simply never get the hang of it. It is a serious problem that lactivists simply fail to address.

Those are the critical foundational lies that lead to deaths, but the are accompanied by a myriad of other, smaller lies about the benefits of breastfeeding. Breastfeeding does not prevent asthma, allergies, diabetes, obesity or anything beyond mild respiratory and mild gastrointestinal illnesses. Breastfeeding does NOT increase IQ.

The latest lie to enter the lactivist catalog of lies is the claim that breastfeeding is a public health issue. There has never been EVEN ONE STUDY that has demonstrated that breastfeeding benefits public health. The studies that make the claim of public health benefits or healthcare saving are all theoretical and are based on the ASSUMPTION that breastfeeding provides benefits that are in reality unproven.

Why are lactivists lying? Lactivism is a business and breastfeeding is their product. True, lactivism does not yield multimillion dollar profits, but for lactation consultants and lactivism advocacy groups it yield 100% of profits. Consider the Baby Friendly Hospital Initiative that credentials hospitals based on whether they meet specific breastfeeding promotion criteria (criteria that ironically have never even been shown to improve breastfeeding rates). The credentialing organization charged more than $10,000 per hospital for the privilege. Extolling and exaggerating the benefits of breastfeeding improve the bottom line.

Lactivists and their organizations are not lying knowingly, of course. Their belief in the benefits of breastfeeding is akin to religious devotion and like religious devotion is not affected by the actual scientific evidence. They believe, they want everyone else to believe, and they will say nearly anything to convince people to believe, that breastfeeding is critical whether it is true or whether they merely believe it is true.

That wouldn’t be a problem if it weren’t for the dead babies. The deaths make a vet big problem indeed. So let’s be very clear on some important facts.

Breastmilk is NOT the perfect food.

In first world countries, the benefits of breastfeeding are TRIVIAL.

And, most importantly, infant formula is LIFE SAVING for many babies.

The truth is that there has never been a single identified infant death from properly prepared infant formula. In contrast there are quite a few babies who have died as a result of exclusive breastfeeding.

Unfortunately, babies will continue dying until breastfeeding advocates stop lying, so they should temper their rhetoric immediately. Otherwise future deaths will rest on them and their irresponsible, damn the consequences, efforts to promote breastfeeding.

 

Addendum: I’ve gotten numerous request for citations to the breastfeeding related deaths so here are several:

Breastfeeding-Associated Hypernatremia: Are We Missing the Diagnosis?

The incidence of breastfeeding-associated hypernatremic dehydration among 3718 consecutive term and near-term hospitalized neonates was 1.9%, occurring for 70 infants…

Conclusion. Hypernatremic dehydration requiring hospitalization is common among breastfed neonates…

Neonatal hypernatremic dehydration associated with breast-feeding malnutrition: a retrospective survey

Hypernatraemic dehydration and breast feeding: a population study

Deaths and near deaths of healthy newborn infants while bed sharing on maternity wards

Although bed sharing with infants is well known to be hazardous, deaths and near deaths of newborn infants while bed sharing in hospitals in the United States have received little attention … These events occurred within the first 24 h of birth during ‘skin-to-skin’ contact between mother and infant, a practice promoted by the ‘Baby Friendly’ (BF) initiative … We report 15 deaths and 3 near deaths of healthy infants occurring during skin-to-skin contact or while bed sharing on maternity wards in the United States. Our findings suggest that such incidents are underreported in the United States and are preventable…

In eight cases, the mother fell asleep while breastfeeding. In four cases, the mother woke up from sleep but believed her infant to be sleeping when an attendant found the infant lifeless. One or more risk factors that are known or suspected (obesity and swaddling) to further increase the risk of bed sharing were present in all cases. These included … maternal sedating drugs in 7 cases; cases excessive of maternal fatigue, either stated or assumed if the event occurred within 24 h of birth in 12 cases; pillows and/or other soft bedding present in 9 cases; obesity in 2 cases; maternal smoking in 2 cases; and infant swaddled in 4 cases.

Why are proponents of delayed cord clamping so sure that it has benefits for term infants despite all the scientific evidence to the contrary?

In part it’s because they have extrapolated inappropriately from existing science. It has been known for some time that delayed cord clamping is beneficial for premature infants. How? Many premature infants develop anemia known, not surprisingly, as anemia of prematurity. As this article on Medscape explains:

All infants experience a decrease in hemoglobin concentration after birth… For the term infant, a physiologic and usually asymptomatic anemia is observed 8-12 weeks after birth.

Anemia of prematurity (AOP) is an exaggerated, pathologic response of the preterm infant to this transition…

AOP spontaneously resolves in many premature infants within 3-6 months of birth. In others, however, medical intervention is required.

Delayed cord clamping provides an auto transfusion in the moments after birth, thereby decreasing the chance that a premature infant will need a blood transfusion for severe anemia.

But term infants don’t suffer from anemia of prematurity, so there’s really no reason to believe that delayed cord clamping is beneficial for them.

However, the real reason for believing that there are purported benefits is that proponents of cord delayed cord clamping come from a midwifery tradition of reflexive defiance. Simply put, many midwives operate on the premise that whatever obstetricians do is “unnatural” and therefore doing the opposite must be better. Not surprisingly, then, the “benefits” of delayed cord clamping were fabricated from whole cloth by a midwife. According to CNN:

What started as a grass-roots movement by UK midwife Amanda Burleigh nearly a decade ago, has recently grabbed the attention of medical doctors around the world. “I wanted to find answers to why so many children, including mine, my friends’ and my colleagues’ appeared to have additional learning and health needs, especially the boys,” said Burleigh. So she started reflecting on her own practice as a midwife.

“I began to question why we were trained to cut the umbilical cord immediately after a baby was born,” said Burleigh. “I then started to explore my theory that there must be a link to a child’s health based on when the cord is cut.” Her curiosity grew into a movement.

In other words, with absolutely no evidence, Burleigh spun a fantasy that her children’s learning and health needs were due to the evil acts of obstetricians, specifically immediate cord clamping.

In the intervening decade there have been numerous studies that were supposed to show the benefits of delayed cord clamping in term infants, but ended up showing nothing much at all.

Two years ago I wrote about the last study to receive substantial media attention in Delayed cord clamping: much ado about nothing, and I included a handy chart:

So the only “benefit”was slightly higher iron stores (a laboratory value), one that has no clinical effect and probably has no clinical significance.

But that hasn’t stopped proponents of delayed cord clamping from continuing their desperate search for benefits.

The latest effort comes from Sweden, and the scientists who conducted the study promoted it breathlessly … as nearly all scientists promote their work whether it is high quality or useless.

From the CNN article:

“It’s incredible to see what a difference an extra three minutes and one-half cup of blood can have on the overall health of a child, especially four years later,” said Dr. Ola Andersson, lead author of the study and a pediatrician at the department of women and children’s health at Uppsala University in Sweden. “This is very promising, but larger studies are necessary,” said Andersson.”

Not exactly.

What was the study, Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age; A Randomized Clinical Trial, looking for?

The main outcome was full-scale IQ as assessed by the WPPSI-III.

What did the author find?

As the chart below demonstrates, they found that delayed cord clamping had no benefit on IQ. Specifically, there was no benefit on full scale IQ, no benefit on verbal IQ, no benefit on performance, no benefit on processing speed and no benefit on general language composition.

But wait!

Fine-motor skills were assessed by the manual dexterity area from the Movement Assessment Battery for Children, Second Edition (Movement ABC), which includes 3 subtests: time for posting coins into a slot (both hands), time for bead threading, and drawing within a bicycle trail…

Delayed cord clamping had no benefit on any of these tests of manual dexterity.

So delayed cord clamping had no benefit on IQ and no benefit on manual dexterity.

But wait! All was not lost:

Parents reported their child’s development using the Ages and Stages Questionnaire, Third Edition (ASQ) 48-month questionnaire, which was translated into Swedish … The ASQ contains 5 subdomains: communication, gross motor, fine motor, problem solving, and personal-social …

On 2 of those 5 parent assessments of their child, fine motor and personal-social, the delayed cord clamping group had statistically significantly better scores.

What does that mean? Absolutely nothing!

In reality, this study demonstrates that delayed cord clamping in term infants has NO appreciable benefits.

The study was conducted to determine if delayed cord clamping has an effect on IQ and found that it doesn’t. The the authors looked at objective tests of manual dexterity and also found no difference. Then they looked at parental assessments of child performance and found a statistically significant difference between in two subsets, but at no point have the authors demonstrated that the small sample of 263 children (which represented only 2/3 of the children originally enrolled) has enough statistical power to be valid.

In other words, the authors failed to find any meaningful benefit in neurodevelopmental outcomes caused by delayed cord clamping.

Contrary to Dr. Andersson’s assertion, the only thing incredible about this study is how brazen the authors are in claiming that their findings are incredible when, in fact, they merely highlight the increasingly desperate efforts to find some benefit, no matter how arcane, from delayed cord clamping in term infants.

The past 20 years have witnessed an ever growing movement to moralize motherhood, from the endless restrictions on what pregnant women can consume (most of them, like the prohibition on alcohol, far outstripping any scientific evidence), the moralization of infant feeding and public pressure to breastfeed (once again far outstripping any scientific evidence), and the promotion of intensive mothering (attachment parenting) whereby the mother’s “real” work is to stay home and raise children. This moralization of motherhood has been justified as an attempt to recapture the supposedly superior lifestyle of our foremothers. But in truth it has nothing to do with science and everything to do with fear of women’s emancipation.

How can I be sure? Because there has been no comparable attempt to moralize fatherhood or return it to the supposedly superior lifestyle of our ancestors. There is nothing equivalent for fathers to the holy trinity of natural mothering (natural childbirth, breastfeeding and attachment parenting).

• When was the last time you saw people claiming that “good” fathers demonstrate their love for their wives and children by killing game animals and dragging them home?
• When was the last time you saw men escorted out of the delivery room because traditional societies do not allow fathers at childbirth?
• Where are the restrictions on what men can consume, justified by the desire to keep their sperm safe for maximum fertility?
• When was the last time you saw fathers harassing each other over who is the more natural father?

Never, right? And that’s not a coincidence.

Obviously any large social movement, like the movement to moralize motherhood within industrialized societies, is complex and multifactorial. Nonetheless, a significant impetus for the movement to moralize motherhood is to return to the olden days … for women, but not for men.

That’s why there are mommy wars, but no daddy wars.

As the pressure mounts on young women, it’s time for a wholesale reassessment of what is really driving the promotion of intensive mothering. Is it really about what’s best for children or is it about what returns women to the home and keeps them from achieving professional and economic success?

I hear the natural mothering crowd yelling that it’s about “the science.” But if the last 20 years have shown us anything it is that “the science” is weak, conflicting and riddled with confounding variables. We cannot pin down the answer to something as basic as whether it is good or bad for children if their mothers work and the reason we cannot pin it down is that there is no one answer. It depends; it depends on the individual mother, and individual child and the life circumstances of the family. It’s just like breastfeeding, where “the science” is also quite fuzzy no matter how much lactivists insist otherwise. That’s because the greatest danger of not breastfeeding comes from contaminated water used to prepare it and that’s not a problem in first world countries. Is breastfeeding better for babies than formula feeding? It depends; it depends on the individual mother, the individual baby and the life circumstances of the family.

The weak “science” of breastfeeding and the weak “science” on working mothers is stronger by far that any science on natural childbirth or attachment parenting. That’s because there is no science at all to support either of those two components of the holy trinity of natural mothering.

And what does the science show about fathering in nature? No one knows, because virtually no one is looking.

In part that reflects the importance of mothers during pregnancy and early infancy, but, I would argue, it also reflects the fact that we use mothering to control women while there is no comparable effort at all to control men through fathering.

As a society we need to step back and ask ourselves why we are placing such pressure on new mothers and why we are demanding that women accede to the imperatives of intensive mothering (and shame them for not doing so), while paying no attention to fathering.

Is this really about what’s best for children? Is this really about “the science”? Or is this yet another, albeit thoroughly modern, way to control women?

Seemingly disparate groups like anti-vaxxers, anti-GMO advocates, foodists like the Food Babe Army, and the anti-fluoride brigade, share one very important thing in common.

Wait, let me amend that.

In addition to ignorance of basic science, statistics and logic these groups share a second important characteristic.

All are cringing, whingeing communities of fear.

They are all defined by what they are afraid of and they are afraid of anything they don’t understand.

Anti-vaxxers don’t understand immunology.

Anti-GMO advocates don’t understand genetics.

Foodists don’t understand toxicology.

Ditto for the anti-fluoride brigade.

And they have chosen to band together and create an identity around that fear.

Sure they tell themselves and others that their communities are united by refusal to gullibly accept the assurances of experts, but their communities are actually united by the fear generated by their gullible acceptance of fabricated warnings from quacks and charlatans.

Consider the foodist cri de coeur: I won’t eat it if I can’t pronounce it.

What it really means is this: If I can’t pronounce it, it’s a big word. If it’s a big word, it might be technical. If it’s technical, I can’t understand it. If I can’t understand it, I fear it.

Imagine if our distant ancestors, the ones the natural living communities harken back to, had behaved in the same fearful manner.

“Fire? OMG, fire is dangerous. People could get burned. There is no way that I am cooking my meat before eating it!”

“Killing animals with spears? What if someone’s aim is off. They could kill me instead of the wild boar. No, I’ll take my chances getting in close and bashing wild animals over the head with my club.”

“Deliberately planting seeds in the ground? You have got to be kidding me! How do we know that the seeds we plant deliberately will grow into plants as safe and nutritious as the ones we gather? They might be poisoned so we better not eat them.”

Or much, much later:

“Central heating with gas? The gas could blow up!! We’ve been using fire to heat our homes for thousands of years; I’ll stick with that.”

“Electricity? That’s hard to pronounce. I’d rather sit in the dark.”

“Sorry, but there is no way I am getting on an airplane. If we were meant to fly, we’d have been born with wings.”

Sounds ridiculous, right? The innovations that make life longer and less arduous today were new and poorly understood once. That made them scary, but being scary is not the same thing as being dangerous. Once people learned more about these innovations, and observed them in action, they embraced them.

Our distant ancestors could be forgiven for fearing innovations since they had no way to understand how they worked. No one understood that cooking meat made it easier to extract more nutrients giving a competitive advantage for societies that cooked their meat over societies that continued to eat it raw. In time, the individuals that ate cooked meat out-competed everyone else, and those that ate meat raw simply died out. The technological innovation of cooking was so advantageous that we actually evolved to eat only cooked meat, the only animals to do so.

Contemporary anti-vax advocates are ignorant because of their own actions. The knowledge of how vaccines work and their efficacy is available to anyone who cares to learn. But anti-vaxxers are like those who whined that if raw meat was good enough for their ancestors, then it’s good enough for them. If natural selection were allowed to work unimpeded, they would simply die out, but not before they made other people sick as well.

Anti-GMO advocates are like the distant ancestors who may have fretted over the innovation of planting seeds in the ground. Who knew what might grow? Certainly not those fretting ancestors who didn’t understand botany, farming or the genetics of improving crop yields. But contemporary anti-GMO advocates have no excuse for their ignorance of genetics beyond their desire to remain ignorant and afraid.

The ultimate irony of course is that it is technology (the internet) that has allowed for the exploding growth of communities of fear of vaccines, food, and “chemicals.” Most of those who create and inhabit the anti-vax, food phobic, and chemical phobic communities can no better explain how their smart phones and tablets work than they can explain how vaccines and genetic modification of food works. Nonetheless, they surround themselves with high tech gadgets, wireless signals and displays that give off electro-magnetic radiation the better to transmit their fear of vaccines, food and chemicals.

The sad fact is that if it had been up to the cringing, whingeing members of these communities of fear, we’d still be living in small tribal bands in caves, eating raw meat and gathering wild grain and tubers. Fortunately, human history has been advanced by those willing to create and use technological innovation, and advanced much further still by those who made the scientific discoveries that led to the many technological advances that we use today.

Sadly, those who are afraid of technological innovations that they cannot understand are still huddling in the proverbial darkness of their internet communities of fear.

When I finished Amy Bentley’s piece about public breastfeeding on Slate I looked for the disclaimer that it was a parody.

Surely no one could take such a ridiculous fantasy seriously? But, alas, Bentley’s piece is yet another example of the ways that lactivists deliberately mangle history to support their own beliefs, albeit a particularly laughable attempt.

Bentley’s piece is titled When Breasts Became Sexy, Breast-Feeding Became Disgusting and the central contention is hilarious: the sexualization of breasts began in the 1800’s and culminated in the mid-20th Century.

Okay, let’s catch our breath from laughing so hard and try to understand what Bentley is trying to argue with that delightfully nonsensical claim.

Bentley is apparently a purveyor of the lactivist revision of history that is attempting to demonize formula while simultaneously ignoring the lived experience of millions of women.

The real history of formula in the US bears no relationship to the lactivist fabrication.

Here’s a convenient chart to help you tell the difference between real history and lactivist history.

In the real history, breastfeeding was ALWAYS inconvenient, often painful, and more than occasionally led to the death of the infant from starvation when his or her mother didn’t produce enough breastmilk. Lactivist history imagines a breastfeeding paradise in every time, place and culture.

Reality is that babies whose mothers didn’t make enough milk (and up to 5% did not) starved to death. Lactivist history pretends that all women produced enough milk.

In reality, doctors invented formula to save the lives of babies whose mother were dead or did not produce enough milk. In the lactivist fantasy, corporations invented formula to profit from it.

In reality, thousand of babies died each year because their mothers fed them cow’s milk rather than breastfeed them. In the lactivist fantasy every mother loved breastfeeding.

In the real world women eagerly adopted the use of formula because they didn’t want to breastfeed. In the lactivist fantasy women were brain washed into formula feeding.

In the real world La Leche League was created by a group of devout Catholic women who believed women shouldn’t work outside the home. Lactivists routinely ignore the real history of LLL.

Bentley had just added two new fantasies to the lactivist revision of history.

In the real world women breastfed within their homes, or perhaps within the casual company of other women. In Bentley’s entirely imaginary history, women breastfed publicly. That would be the same women who weren’t allowed to show their ankles in public, were swathed in layers of corsets and fabrics, and weren’t allowed outside the home except in the company of an escort, etc.

But Bentley’s best revisionist attempt at history is her most hilarious: the idea that breasts only became sexualized with the past 200 years.

Her article would be nothing more than a punchline except for one thing: It is a slap in the face to the millions of women who wanted to breastfeed but couldn’t. It is a slap in the face to the millions of women who watched their babies starve to death. It is a slap in the face to the mothers who did then and continue now to find breastfeeding difficult, painful,  and inconvenient. It is a slap in the face to the millions of women who don’t want to share their breasts with their babies. And most of all, it is a slap in the face to the millions of women who don’t have the opportunity to breastfeed because they have to be in the workplace so that their children won’t starve to death.

Moreover, it is based on a fundamental lack of respect for women. It rests on the assumption that women are silly little things who can’t think for themselves, have no authentic feelings and are easily manipulated by corporate interests. It utterly ignores the fact that women are sexual beings who may view their breasts as sexualized, and instead substitutes the profoundly misogynist assumption that sexuality is the sole purview of men.

Bentley has unwittingly joined the sexist effort to keep women figuratively barefoot and pregnant by glamorizing their function of their reproductive organs. Whether it is natural childbirth, lactivism or attachment parenting, advocates conjure a blissful past that never existed in order to keep women in the home.

Bentley’s piece elevates the lactivist revision of history to farce. The idea that women breastfed in public is utterly absurd and indeed Bentley herself can find no examples in photographs, art, literature or anywhere else. The idea that breasts were sexualized within the past 200 years is beyond absurd.

The truth is that infant formula, like other forms of technology such as the birth control pill, and epidural anesthesia are instruments of women’s empowerment and liberation.

To Bentley and her cohorts I say this:

You cannot force us back into the home no matter how much you glamorize reproduction, no matter how much you ignore our lived experiences, and no matter how ludicrously you rewrite history!

There’s a sucker born every minute.

That was my thought when I saw the NBCNews.com piece Taco Bell and Pizza Hut Chuck Artificial Ingredients.

Taco Bell and Pizza Hut have announced they’re getting rid of artificial colors and flavors, becoming the latest national food retailers to “go natural.”

Instead of “black pepper flavor,” for instance, Taco Bell will start using actual black pepper in its seasoned beef.

Taco Bell also said it will remove trans fats and high-fructose corn syrups from most of its menu by the end of the year…

Chipotle recently said it had nearly finished removing genetically modified ingredients from its stores. Subway, the subject of an online campaign to remove an ingredient in its food also found in yoga mats, also updated its ingredient list. And in February, Nestlé pledged to replace “vanillin” in its Crunch bars with natural vanilla flavor, along with other changes to remove artificial colors and flavors.

Ahhh, the power of marketing!

But the reality is that the food from Taco Bell and Pizza Hut wasn’t healthy before and it won’t be healthy when it’s all natural. That’s because “naturalness” has nothing to do with health, no matter how much the food-phobes insist that it does.

Who are the food-phobes?

They are the quacks and charlatans who create communities of fear around food, cringing and whingeing about everything from artificial flavors to genetically modified foods.

Taco Bell and Pizza Hut are following Chipotle into attempting to convert these communities of fear into customers. As PT Barnum once said, you can’t go broke underestimating the intelligence of the American public.

The ultimate irony, though, it that most of us would not be here if it weren’t for technology and artificial ingredients and treatments. For most of human existence, natural has been synonymous with deadly not healthy.

Deadly viruses and bacteria are all natural.

Famines are all natural.

Nutrient poor plants are all natural.

Droughts, floods, earthquakes and tornadoes are 100% natural, too.

For hundreds of thousands of years not a single individual died from artificial anything, but human beings died in droves. They died in childbirth; they died of bacterial and viral illness; they died being mauled and eaten by wild animals; they died of exposure to the extremes of weather and they died in natural disasters.

In 2015, in first world countries, the deaths rates prior to old age have never been lower and lifespans have never been longer. Nonetheless, people have convinced themselves that if they returned to the natural lifestyle of their ancestors they will live longer and be healthier, in direct contradiction to the unassailable fact that those ancestors were neither healthier nor longer lived.

Why? Because they have transmuted the entirely human fear of illness and death into a fear of chemistry. They don’t understand chemistry so they are afraid of “artificial” chemicals.

They are living in a world of fear of their own making by conveniently ignoring the fact that it is “artificial” ingredients and treatments have ensured that they are still here to be afraid.

I’m 56 years old, and my story is typical. I could honestly tell you that as an adult I have rarely been sick. I can only recall two times that I ever was sick enough to miss work: the first was when I had breastfeeding related mastitis and my temperature soared to 104; the second occurred because I was exposed to chickenpox and was not immune since no vaccine existed when I was a child. I missed work to protect the patients, not to protect me.

But I can also tell you that I have rarely been sick because I have relied heavily on profoundly artificial treatments and preventatives. Indeed, without them I would probably be dead.

I never faced the scourges of smallpox, diphtheria, pertussis, rubella or polio because I received vaccines.

My vision is poor because of nearsightedness. In paleolithic times I would have died being eaten by a predator or falling off a cliff that I failed to see. Instead, I have always had 20/20 vision because of glasses, made from that artificial ingredient glass. More recently, I have maintained 20/20 vision through plastic: contact lenses.

I gave birth to 4 healthy children, and never had to worry about dying in childbirth.

I was able to limit the number of pregnancies I experienced by the use of contraceptives, and therefore further reduced the risk of dying of pregnancy related complications.

When I was 40, I developed an all natural benign brain tumor that affected my vision. In nature, it would have ultimately killed me, but not until I had suffered excruciating headaches for years. Instead, I had a single treatment with radiation and it shrunk to the point where it no longer caused symptoms.

At 45 I developed all natural narrow angle glaucoma. Narrow angle is much less common than typical (wide angle) glaucoma, and is due to a structural defect in the eye. A laser was used to open channels between the anterior and posterior eye. It took 5 seconds and cured the problem. Without it, I inevitably would have become blind.

At 45 I also developed high blood pressure, now well controlled on anti-hypertensive medications.

At 50 I developed gallstones. Within months I had my gallbladder removed through the laparoscope, a procedure so simple that I went out to dinner the following night.

I could go on, but I think you get the point. Nature has thrown me a bunch of health curves and I’ve caught them all with the aid of “artificial” chemicals and procedures.

As far as I’m concerned, if you are gullible enough to believe that the problem with Taco Bell and Pizza Hut was the artificial or GMO ingredients in their products, instead of the all natural fat and sugar, then Taco Bell and Pizza Hut are entitled to trick you that their products are now healthy because they are natural.

In the meantime, make mine (food, vaccines, medications) an Artificial … and make it a double!