A guest post from frequent commenter NoLongerCrunching:

I am a lactation consultant (IBCLC) with 13 years of experience helping breastfeeding mothers, from initiation to weaning. I did not put my name on this article because I do not want to be ostracized by my colleagues by writing for “she who must not be named.”

I believe deeply in the value of the lactation consultant profession, but I am afraid for its future. Why? Because when we are given feedback by mothers who have had negative experiences with LCs such as Emily Wax Thibodeaux’s story Why I don’t breastfeed, if you must know, recent guest writer Anne’s post A mother shares her experience with lactivism, guilt and postpartum depression, and Suzie Barston’s (the Fearless Formula Feeder) story, many of us respond with one of the following (paraphrased quotes I have heard on IBCLC groups and around the office):

• “That would never happen in our hospital.” (spoiler alert: yes it would)

• “Mothers may feel criticized when I say they need to do more breastfeeding/pumping/skin-to-skin but I am just giving accurate information and am not responsible for how she takes it.”

• “The mother needs someone to blame for her breastfeeding failure; she should have followed my recommendations.”

• “The person who said that must not have been an IBCLC. We are always getting blamed for what nurses or lower-level breastfeeding advocates say.”

And of course let’s not leave out the sighs, eyerolls, and head shaking.

Many mothers whose babies are showing clear signs of needing supplementation are afraid to introduce formula, because there has been so much speculation about the harm of “just one bottle”. The attitude in the “baby-friendly” hospital is to treat formula as risky and only to use it when the baby is in trouble or about to be. (Some might argue that any formula has risks; however, the theoretical risk of a little supplemental amount is almost certainly clinically irrelevant in the long term.) Ironically, sometimes early supplementation can save the breastfeeding relationship, because when the baby does not get enough calories, he will become lethargic at breast, causing poor stimulation of the mother’s milk supply, which then becomes a downward spiral of more lethargy at breast and eventually a permanently lowered supply. This has been shown by research, but read the comments to see the resistance of lactation professionals to this possibility. If the study results are true, wouldn’t it result in babies being breastfed longer, which is what we are working for? We are talking about the possibility of a few 10 ml formula feedings resulting in potentially hundreds of ounces of breastmilk going into those babies. Not to mention the months or years of cuddly nursing sessions mother and baby will enjoy.

By brushing off these women’s experiences and research that contradicts our mindset, we are losing an opportunity to learn how we can be better lactation consultants. No one benefits from an adversarial relationship — not the mothers, not the babies, and not the lactation consultant profession. I have gone to many a hospital room only to be pulled aside by the nurse and told that the mother does not want to see any LCs. She would rather struggle alone than face someone whose level of compassion she cannot be sure of.

The only acceptable response to a woman who says an LC has shamed her is to believe her. She needs empathy about how devastating it must feel to be criticized about your first actions as a mother. Hearing her experience can remind us that part of our job is to leave our patients feeling confident that they can meet their baby’s need for food and comfort, and they have a doable plan to meet their breastfeeding goals. In the words of Linda Smith, IBCLC and lactivist extraordinaire, the three rules of breastfeeding support are “1. feed the baby, 2. the mother is right (if she is wrong, refer back to #2), and 3. it’s her baby.” Our patients should feel that we will not be disappointed in them if they call from home saying “I was unable to follow the plan we developed, so can we go back to the drawing board?”

If an LC carries judgment in her heart, vulnerable new mothers can sense her disapproval quite acutely; these patients will not feel comfortable telling her they did not follow the plan and they need a different one. Sadly I hear colleagues often talk about these mothers as if they are lazy, selfish, or uncommitted to their babies’ health. Yet often they have had days of grueling labor (sometimes ending in so-called major surgery) and have gotten fewer than 3 consecutive hours of sleep over the past 3 days. Remember that sleep deprivation is used as a torture technique. If these mothers have been breastfeeding, then supplementing, then pumping, they are expending the same amount of time as a mother of triplets. Doing this every 3 hours gives them at best a 2-hour break. Cuddling with the baby takes a backseat. Sleeping to replenish their energy takes a backseat. The mother spends time hooked up to a milking machine while dad or grandma gets to experience the joy of seeing the baby go from hungry to the bliss of a full tummy.

Instead of reacting with frustration towards these mothers, we need to listen to them and tailor our recommendations to what they tell us honestly they can do. And the only way a mother will trust us enough to be honest is to never breathe a whiff of judgment, which is impossible if you are secretly judging her.

Depending on what the mother says is feasible to do, the plan may or may not result in a full milk supply, (infrequent or insufficient milk removal usually results in low production); however, partial breastfeeding is almost always more satisfying to a woman who wanted to breastfeed than feeling the need choose between just giving up and going to exclusive formula feeding, or facing what Anne described as being “miserable beyond belief” and potential severe PPD. When we start with what mothers tell us they can do, we can usually develop a plan that results in frequent effective milk removal and the baby transitioning to exclusive breastfeeding, while still allowing the mother to enjoy her new baby. The mother should be given all the options and be confident that we will support whatever decision she feels is best.

Another thing about helping a mother develop a good milk supply: Which is more likely to result in a higher level of oxytocin and prolactin: an environment where the mother feels cared for, safe, and respected — or an environment filled with subtle disapproval and pressure to doubt her instincts, potentially increasing the stress hormones cortisol and adrenaline?

What can mothers do to evaluate whether their LC is silently judging them?

First of all, realize that you are not crazy; if you are picking up subtle judgmental vibes, you are probably right. Second, if you are feeding, cuddling and listening to your baby’s cues, you are doing mothering right. Your success as a mother is not measured in how many milliliters of breastmilk you produce, whether you can achieve a perfect latch, whether you are glowing like a Madonna when you breastfeed. Third, make your own needs as high a priority as the baby’s needs, because you matter as a human being, and because a happy mother is the heart of a happy family.

I desperately hope my profession can move closer to being more mother-friendly, rather than single-mindedly focused on getting as many mothers as possible to exclusively breastfeed. Whether or not they leave our care exclusively breastfeeding is not in our control; what is in our control is how we treat the mothers who are struggling, even the mothers who do not follow our advice. Although there is pressure in the hospital environment to justify our jobs by percentage of babies exclusively breastmilk-fed at discharge, we have an ethical responsibility to make sure the baby gets enough calories and to make sure the mother feels like she is capable of meeting her baby’s need for food. By “enough calories,” I do not mean a stingy amount to keep the baby hungry for breastfeeding; I mean enough so the baby shows satiety cues at each and every feeding. Another try at breastfeeding is coming around the bend; in the meantime, doesn’t the baby deserve to feel satisfied? Doesn’t the mother deserve to see her baby full and happy?

Most of my patients desperately want to breastfeed and are very grateful for professionals that help them feed in the way they want to. But in order for this profession to have a future, which will enable us to help future mothers feed at they choose, we need to take a hard look at ourselves. We need to let go of judging mothers in our hearts. We need to let go of any attachments we may have toward an outcome that mirrors our own feeding choices. We need to follow the excellent advice of IBCLC Chris Musser, to seek first to understand.

Proving yet again that newspapers should not opine on medical issues, The New York Times tackles the safety of midwifery in Are Midwives Safer than Doctors?

Let’s leave aside for the moment the fact that the Editors don’t really understand the new UK recommendations and their back story, and let’s focus the misogyny directly regurgitated from the propaganda of the natural childbirth movement.

Doctors are much more likely than midwives to use interventions like forceps deliveries, spinal anesthesia and cesarean section.

Oops! Spinal anesthetics are used for planned surgeries; the Editors are apparently referring to epidurals.

An epidural, the single most effective method for relieving the agonizing pain of childbirth, is an interventions?

Since when, dear Editors, is treating pain an intervention? Oh, right, when it’s women’s pain. No one ever thinks treating men’s pain is an intervention, do they?

The truth is, however, that adequately treating women’s pain, in childbirth or from any other cause, is a feminist issue.

Let’s look at some empirical facts about labor pain:

1. Childbirth is excruciatingly painful. Indeed the pain of childbirth is so impressive that ancient cultures imagined that the only possible explanation was divine punishment of women for their transgressions.

2. Severe pain should be treated. No one would ever suggests that cancer pain be ignored or that pain from a broken bone should go untreated.

3. Medical professionals have an obligation to treat pain. Every human being is entitled to the medical treatment of pain if that’s what he or she desires.

But all too many midwives, prisoners of the philosophy of natural childbirth, view birth as a piece of performance art, wherein a woman demonstrates her intrinsic worth by attempting to recapitulate childbirth as they imagine it occurred “in nature” (minus all that death, disability, subsequent incontinence, etc., of course); that means no relief for excruciating pain.

In other words a woman’s need for pain relief is rendered invisible.

How do natural childbirth advocates do it?

• Blaming the woman for her own pain – if she did it “right,” childbirth would not be painful.
• Blaming the woman for not using “natural” methods of pain relief – regardless of their questionable value in providing adequate relief.
• Blaming the woman for not embracing the pain as an “empowering” aspect of her biological destiny.
• Blaming the woman for not understanding that childbirth is “good” pain, even though it is biologically identical to all other forms of severe pain.
• Treating women’s need for pain relief as an “intervention,” although, to my knowledge not a single form of pain relief for men is ever considered an intervention.

Simply put, according to natural childbirth dogma, a woman’s pain in labor is irrelevant.

There is a long and disreputable history of ignoring women’s pain.

The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain, Journal of Law, Medicine & Ethics, 29 (2001): 13–27, provides a disturbing description of the ways in which the pain of women is systematically devalued, disbelieved and undertreated.

Given that women experience pain more frequently, are more sensitive to pain, or are more likely to report pain, it seems appropriate that they be treated at least as thoroughly as men and that their reports of pain be taken seriously. The data do not indicate that this is the case. Women who seek help are less likely than men to be taken seriously when they report pain and are less likely to have their pain adequately treated…

The study by McCaffery and Ferrell of 362 nurses and their views about patients’ experiences of pain found that while most of the nurses (63 percent) agreed that men and women have the same perception of pain, 27 percent thought that men felt greater pain than women. Only 10 percent thought that women experienced greater pain than men in response to comparable stimuli. This result has no justification in the literature … The same study also found that almost half of the respondents (47 percent) thought that women were able to tolerate more pain than men as compared to 15 percent who felt that men were able to tolerate more pain than women…

These erroneous attitudes are particularly prevalent in regard to childbirth:

Bendelow found that “the perceived superiority of capacities of endurance is double-edged for women — the assumption that they may be able to ‘cope’ better may lead to the expectation that they can put up with more pain, that their pain does not need to be taken so seriously.” Crook and Tunks point to the influence of the psychoprophylaxis movement in the United States with its implicit assumption that it is good to experience childbirth without the aid of analgesia. As a result, some women who have “gone through psychoprophylaxis classes, feel guilty if they relent at the last minute and ask for an epidural”; according to the authors, “these attitudes imply that we have a value system endorsed by some parts of our population that suggest women should be encouraged to keep a stiff upper lip.”

Most natural childbirth advocates appear to be unaware of the deeply sexist and racist history of the philosophy of natural childbirth. Grantly Dick-Read, the found of the philosophy, was a eugenecist who was preoccupied with visions of “race suicide” with primitive people overwhelming white people of the “better” classes. He thought that upper class women could be diverted from their insistence on greater political and economic rights back into the home where they belonged if only they didn’t fear the pain of childbirth. Therefore, he told women that the pain of childbirth was all in their heads; he lied in claiming that primitive women (i.e. black women) experienced painless childbirth because they were unafraid of it. In other words, the pain of childbirth is all in women’s heads. Never mind that is was a spectacular lie with a sexist, racist purpose. Contemporary natural childbirth advocates are still spouting the same misogynistic clap trap, counseling women that childbirth pain is a result of fear.

The end result is that, women’s pain is discounted and ignored, and treating women’s pain is derogated as an “intervention.”

But, dear Editors, women’s pain is should NOT be discounted and ignored. The treatment of women’s pain is never an intervention; it is feminism at its most basic.

Claiming that treating childbirth pain is an intervention is both brutally misogynistic and hideously cruel.

Please correct your mistake as soon as you possibly can.

PT Barnum famously said that you can’t go broke underestimating the intelligence of the American public and blogger Vani Hari (Food Babe) is demonstrating the truth of that adage. Her artful manipulation of her Food Babe Army would warm Barnum’s heart.

Like Barnum, Hari depends for her money on the gullibility and lack of sophistication of her followers. They are so naive that they seem to have no awareness that Food Babe is a business, and they’ve been duped into buying an endless array of its useless products.

Maybe Vani’s followers are having trouble seeing Food Babe for the business that it is. Perhaps we should identify what Hari does by giving a nickname to her business; I suggest “Vansanto.”

Barnum at least had to put on his circus and that costs money. Monsanto at least has to create poducts that actually do something. “Vansanto” doesn’t have to do anything to rake in the dough. Hari, the “chief executive” of Vansanto, has figured out how to monetize fear, and that’s free, especially when you create it yourself.

I could spend a lot of time debunking Hari’s claims one by one, but I suspect that wouldn’t be very effective, because her followers lack the knowledge of basic science needed to understand them in the first place. But even those who never learned chemistry should have learned cynicism. They should be able to recognize a marketing ploy when they see one.

“Vansanto” is no more committed to your health and wellbeing than Monsanto is. Both are businesses that make money by promoting and selling products. Monstanto sells a range of products some of which have tremendous value, some of which have serious side effects and all of which fill Monsanto’s coffers.

“Vansanto” promotes and sells a range of products all of which have no intrinsic value since don’t do anything besides line Vani’s pockets. They only have value when you’ve been convinced to fear the less expensive, often far more effective, conventional alternative. That’s where Vani’s true brilliance comes in. She knows that her claims don’t have to make sense and don’t even have to be true; they just have to create fear and Vani is very, very good at doing that.

What’s amazing is that The Food Babe Army is oblivious to what seems pathetically obvious to me. Vani Hari creates fear in order to monetize it. “Vansanto” is no different from Monsanto in that regard. It is an enterprise that exists to create value and profit for its shareholders regardless of whether its products help or harm people.

Maybe members of the Food Babe Army could explain to me why they can’t see this. Is there a single member of the Food Babe Army that hasn’t been convinced to buy either a product that Vani sells, or to forgo buying a conventional product for one that Vani recommends? Is there a single member of her Army who isn’t supporting her with their own money? Can’t you see its about the money, not the food? Can’t you see that there’s no real difference between “Vansanto” and Monsanto except that one makes money for her and the other doesn’t?

Don’t you see that Vani Hari sparked your fear and you are now willing to pay her to make the very fear that she created go way? That doesn’t mark you as educated; it marks you as gullible, and profitable, fools.

Homebirth advocates, help me out here.

I’m having a problem understanding your math. It’s just arithmetic, so it really shouldn’t be so hard, but I can’t figure it out.

It s widely claimed that there is a midwife shortage in the UK. There aren’t enough midwives to safely care for the women giving birth in hospitals. That’s certainly how the Royal College of Midwives (RCM) rationalizes any and all poor care leading to the preventable deaths of mothers and babies.

Here’s where the arithmetic comes in:

1 midwife in the hospital can take care of multiple laboring women (let’s say 3 for arguments sake, though it is probably more)

but 1 laboring woman at home is supposed to be attended by 2 midwives

If I’m doing the addition correctly that means that 2 midwives can care for 6 women in the hospital, but only 1 woman at home … AND midwives are in short supply.

So, isn’t homebirth a selfish, unsustainable use of scarce resources?

Doesn’t every midwife who heads out to marinate in her own delicious autonomy at homebirth deprive 3 women of hospital based midwifery care?

And how can a selfish, unsustainable use of scarce resources possibly be cost effective?

It can’t, can it? And all the hopping up and down by the RCM and NICE claiming that homebirth saves money is a blatant falsehood since it doesn’t take into account the salaries of all the extra midwives who would have to be hired to provide homebirth services, right?

Let’s put it another way:

If it takes 6 midwives to properly care for 18 laboring women in the hospital, but there are only 5 midwives available, how can it possibly be cost effective, sustainable, or even remotely safe to send 2 of those 5 midwives to a homebirth, leaving just 3 midwives to care fo 18 patients?

The RCM and NICE are like Marie Antoinette who, when told that poor people had no bread, supposedly declared, “Let them eat cake!” Only in their case, when confronted with the fact that a woman often can’t get 1 midwife to care for her in the hospital (whose labor wards are routinely refusing to accept patients when understaffed), declare that she should have stayed home so 2 midwives would come to her.

In a system like the UK, homebirth is selfish, usustainable, saves no money, and compromises the care of everyone except the woman who has a fully staffed homebirth. The only people who appear to benefit from this faulty arithmetic are midwives. Who would have guessed?

Regular readers of this blog know of my ongoing interest in natural parenting as both a function of privilege and a marker highlighting privileged status. It seems that many people have a need to signal their privileged status to others by adopting lifestyles and routines that require substantial steady incomes to support.

It’s pretty obvious when it comes to conspicuous consumption of expensive cars, designer clothes, and monstrously large homes. It is less obvious, though no less important, in never ending task of avoiding “toxins” involving the purchase of organic foods, supplements, homeopathic remedies, etc. etc. It turns out to be very expensive to avoid “toxins.”

The concept of natural parenting as a visible marker of privilege raises an interesting and ironic possibility. Is natural parenting, often viewed as a rejection of contemporary consumer culture, merely a niche form of the very same consumer culture that is purportedly being rejected? In other words, just as the women who feed their children McDonald’s take out, let them play with plastic toys, and allow them to watch TV are obviously responding to rampant consumerism, are natural parenting advocates who hire doulas, treat everything with homeopathic remedies, and wear their babies in slings unwittingly responding to the exact same consumerism they claim to deplore, albeit consumerism carefully targeted specifically, at them?

Is natural parenting about health or is it just a giant marketing tactic created to sell worthless products to gullible people? Do purveyors of natural parenting goods and service promote “shopping your way to safety”?

Rutgers sociologist Norah MacKendrick raises this disturbing possiblity in her paper More Work for Mother; Chemical Body Burdens as a Maternal Responsibility published in the September issue of Gender and Society.

… This article advances … the effort to mediate personal exposure to environmental chemicals through vigilant consumption as a new empirical site for understanding the intersections between maternal embodiment and contemporary motherhood as a consumer project. Using in-depth interviews, I explore how a group of 25 mothers employ precautionary consumption to mediate their children’s exposure to chemicals found in food, consumer products, and the home. Most of the mothers in the study situate their children’s chemical “burdens” within their own bodies and undertake the labor of precautionary consumption as part of a larger and commodity-based motherhood project…

MacKendrick firmly situates attachment parenting [intensive mothering] as a consumer choice:

The ideology of intensive mothering infuses spaces of consumption by urging mothers to buy with the best interests of the child in mind. Consumption is therefore entangled with other routine activities that parents—and mothers in particular— view as integral to securing a child’s future outcomes. Indeed, women’s transition to motherhood is marked by the consumption of specific material goods. As a form of daily provisioning, foodwork is gendered labor, as women do most of this work …

Mothers create elaborate rituals around shopping for and purchasing items that they believe are necessary to avoid “toxins.” For example:

Megan, a middle-class woman with an infant, has a complex precautionary consumption routine … She consults books, magazines, and websites to find information about chemical avoidance and organizes her shopping list according to what items should be
organic and nontoxic (e.g., meat, dairy, produce, cleaning products). …

So Megan peruses magazines and websites (filled with ads for products she might purchase), then makes specific product choices in areas ranging from food to cleaning products. What’s the difference between Megan and the woman who peruses Vogue and then makes specific product choices among designer options? Nothing, really.

And, of course, like most natural parenting, the conspicuous consumption is traditionally gendered.

Megan explains that her husband “is on board with it, but he definitely doesn’t initiate. It just wouldn’t enter his realm of thought.” When he does the grocery shopping, she “send[s] him out” with a list of specific brands of items to buy for their child, as she
would not trust him to make the “right” choices. This contrast of her knowledge against her husband’s relative ignorance rationalizes the gendered division of precautionary consumption within her household.

Living a privileged life in a privleged neighborhood is almost a necessity:

Megan lives in a neighborhood with stores selling free-range chicken and discount organic foods. During our interview, she shows me a baby chair that she bought at a local store, and speaks enthusiastically about the natural wood and organic cotton. Megan clearly feels that shopping in a precautionary way is enjoyable. She talks positively about the range of choice of organic goods in her neighborhood: “It’s great . . . it’s a foodie
neighborhood for sure…” When Megan frames precautionary consumption this way, we see the privileges afforded by her social class position, where buying green commodities is easy,
enjoyable, and affordable.

Moreover, shopping your way to safety offers women an unmerited sense of superiority, as another mother demonstrates:

Cara considers precautionary consumption as an expression of vigilant mothering that protects against health problems: “I want it to be organic, to be as pure as possible—you know, they can put a lot of crazy ingredients in there . . . that’s why all these kids are medicated, they’re eating all this crappy stuff and then they can’t behave themselves and what’s it doing to them?” Her approach to precautionary consumption evokes both
a natural mothering and an intensive mothering ideology… By pointing to “all these kids,” Cara furthermore situates herself in relation to a hypothetical, careless parent who fails to connect a child’s ingestion of chemical additives to behavioral problems.

While Megan and Cara claim, and probably even believe, that they are protecting their children’s health by avoiding “toxins,” they’ve actually been tricked into paying top dollar for products they doesn’t need, don’t make their children safer, advertise their privilege, and provide no additional value for the additional expense. They are no different from the less privileged women they look down upon for responding to the consumerist culture in which we live. They, too, has been manipulated into buying stuff in response to aggressive marketing campaigns, just different ones.

Simply put, “toxins” aren’t a health threat, they’re a sophisticated marketing tactic designed to trick privileged women who imagine themselves as “educated” into buying an endless array of consumer products in an orgy of conspicuous consumption that they don’t need, don’t work, and merely enrich charlatans.

Warning, warning, warning: personal opinion ahead!

A recent piece in Slate by David Auerbach made me very angry:

When my 4-year-old told me the other day that she was “ready for princesses,” part of me died. Not just because the day had finally arrived when that virulent meme had infected her, but also because of how utterly powerless I was to contain it. Let me be clear: These weren’t progressive princesses … This kind of princess forced my programmer wife and me to do what we swore we’d never do to our child, which is deny our daughter a book….

Just what we need: another sanctimonious parent teaching another girl that her own feelings are worthless, that femininity is incompatible with ambition, and girls are inferior to boys.

To understand what I mean, imagine a parent uttering the following:

When my 4-year-old told me the other day that he was “ready for firetrucks,” part of me died. Not just because the day had finally arrived when that virulent meme had infected him, but also because of how utterly powerless I was to contain it. Let me be clear: These weren’t progressive fire prevention technologists; they weren’t white collar professionals who invent flame retardant fabrics or teach materials engineering at MIT. These are blue collar firemen, lacking a college education, and downwardly mobile compared to my programmer wife and me, and that forced us to do what we swore we’d never do to our child, which is deny our son a book.

When you picked yourself off the floor where you’d fallen from laughing so hard, you’d probably point out a few facts of life to me: 1. a four year old’s interest in firemen does not mean that he will become a fireman as an adult (not that there’s anything wrong with that). It does not mean that he is imbibing the message that a college education is not needed to get a good job. It does not mean that he is learning to value physical strength over intellectual achievement.

It means nothing. Lots of little boys are fascinated with firemen, claim to want to be firemen when they grow up, and it never amounts to anything, because 4 year olds grow and change, learn a great deal more about the world and themselves, and generally leave childhood ambitions behind.

What’s the difference between the little boy who loves firemen and the little girl who loves princesses? The little boy’s preferences are masculine and that’s A-ok; the little girl’s preferences are feminine and that’s disappointing and must be stopped. Perhaps even more importantly, the little boy’s preferences are seen as authentic, but the little girl can’t be trusted to know her own little four year old mind. His desires are trustworthy; hers are the product of a “virulent meme.”

Why do so many progressives insist that women and girls are disproportionately afflicted with false consciousness? Why are they teaching women and girls not to trust their own desires, to suppress their wishes and to reject their femininity as incompatible with approved accomplishments like being a programmer (nothing against programmers; my eldest son and my daughter-in-law are both programmers)?

I have news for progressive parents: There’s nothing wrong with princesses. There’s nothing wrong with dresses. There’s nothing wrong with pink. It’s an age appropriate phase for 4 year old girls. If you hadn’t noticed, they’re different from 4 year old boys, NOT inferior, different, and those differences should be respected, NOT dismissed as the product of indoctrination, or, worse, inferior to the preferences of 4 year old boys.

Why is that most 4 year old sons of programmers who yearn to be firemen don’t end up as firemen? Because they imbibe the values of their parents that higher education is admired by their parents and considered necessary for a fullfilling life and a renumerative career. The fireman ambition was just a phase, not a trajectory.

The same thing applies to 4 year old girls and princesses. They too imbibe the values of their parents about education, about the respect that should be accorded to women, about the relative roles of husband and wife within their family, about their parents’ views on the limits or lack of limits on a girl’s ambition. The princess ambition is just a phase, not a trajectory.

The prospects facing women in industrialized countries are better than they have been in the past, but are still limited by less pay for equal work, gender discrimation and harrassment, lack of access to reproductive control options and other systemic failures. None of it is in any way related to 4 year old girls who love princesses.

We should be teaching our daughters that femininity is perfectly compatible with ambition and achievement. Banning princesses teaches the opposite, that femininity should be a source of shame, that they can’t trust their own feelings, and that making daddy and mommy look good to their progressive peers is more important than following your dreams wherever they may take you.

Why don’t skeptics confront childbirth woo?

The same people who vociferously defend the efficacy and safety of vaccines, who fight against climate deniers, who battle valiantly against creationists, generally give childbirth pseudoscience a big, fat pass. Google the words skeptic and vaccines and you’ll find tens of thousands of sites and articles. Google skeptic and evolution and you will find even more. Google skeptic and childbirth, and you’ll find very few articles, most of them written by me.

My experience on Reddit, which has an active community of skeptics, indicates that far from questioning the pseudoscience of the natural childbirth and lactivism industries, skeptics have fallen for the same marketing tactics that have fooled so many women. Post or comment on an item questioning the science behind natural childbirth advocacy and you’re just as likely to be accused of “hating” midwives as you are to be supported in deconstructing their faulty, anti-scientific claims. This is unfortunate for skepticism, for women and especially for children, the victims of so many different forms of pseudoscience, (anti-vax, supplements, chiropractic, chelation therapy for autism, etc.)

Since most skeptics are men, I suspect that part of the reluctance to deconstruct and denounce the absolute nonsense spewing forth from many midwives, doulas, childbirth educators, lactivists, and birth and breastfeeding bloggers stems from the fact that they aren’t especially interested in childbirth and breastfeeding. Nonetheless, they ignore childbirth pseudoscience at their own peril.

Why?

Childbirth woo is the gateway to all other forms of health woo.

Combating childbirth pseudoscience would go a long way toward reducing the influence of quackery of all types, particularly anti-vaccination.

Ask any healthcare executive, and he or she will tell you that women are the undisputed healthcare decisions makers in any family. That’s why marketing of health plans and hospitals is often directed to them.

Women have long been the undisputed family health care decision-makers, making approximately 80% of family health care choices. According to a recent Kaiser Family Foundation report, they also choose their children’s doctors (85%), take them to appointments (84%), and ensure they get recommended care (79%).

In short, they are the researchers, networkers, and hands-on care advocates. They are also social network power users. So they’ve taken their health activities online in “peer-to-peer health care”, which allows them to seek and share health advice from others at Information Superhighway speed and scale.

Their influence, already paramount within a family, extends to other families through the internet.

Women’s health care influence has moved beyond the family. … [N]early 70% of women use social networking sites, where they influence the health care decisions of the women in their online communities and those of their families. In a recent report, nearly half of consumers said social media-derived information would affect their health care decisions.

For most young adults, childbirth is their first experience with the healthcare system. And when a young woman finds out that she is pregnant, she heads to the internet for information. What does she find?

She finds a space dominated by a multi-million dollar natural childbirth industry busily hawking books, workshops, courses, movies (e.g. The Business of Being Born), childbirth education classes, hynobirthing tapes, doula services and placenta encapsulation “specialists.” It is a typical pseudoscience world of internal legitimacy with faux experts adorned with faux credentials, conferences, and journals (Birth: Issues in Perinatal Care, which masquerades as a peer review scientific journal, is actually published on behalf of Lamaze International, though you’d be hard pressed to find evidence of that connection on line). The natural childbirth and lactivism industries have created a vast echo chamber where it is possible to navigate literally hundreds of interconnecting sites without ever coming across actual scientific evidence. In other words, for many (? most) young women, their first experience of medical science is mediated by quacks.

This has important implications not only for childbirth choices, but for all health choices down the line.

Because the primary product of the natural childbirth industry is distrust of medical providers. Doctors, scientists and public health officials are supposedly all in the pockets of Big Medicine and Big Pharma. Anyone who questions the myriad near magical properties of breastmilk (“squirt it in your baby’s eye to treat conjunctivitis”) is in the pocket of Big Formula. The foundational message of the natural childbirth industry is that doctors, scientists and public health officials don’t care about your health or your baby’s health. They will actually actively try to hurt you to line their own pockets.

Sound familiar? It should. It’s the bedrock claim of all “alternative” health, especially vaccine rejection.

As a recent “Dear Prudence” column on Slate demonstrated, the natural childbirth industry is often the initial purveyor of the anti-vax message. The natural childbirth community is a particularly fertile area from which to recruit parents wavering on the issue of vaccination, especially after they have been primed by the message that doctors, scientists and public health officials are trying to hurt babies, not help them.

Childbirth is not a peripheral area in healthcare pseudoscience, it is ground zero. It is the gateway to the mirror world of pseudoscience, where experts are supposedly trying to harm you, high school graduates consider themselves qualified to opine on complex health issues and everyone has an online store.

I implore fellow skeptics to take note.

The stories about your experiences with natural parenting and guilt have started arriving in my inbox and they are by turns amazing and distressing and often both. One story struck me so profoundly that I asked permission of the author, Adrienne, to share it with you. It is an object less in how lactivists in their ignorance and commitment to the ideology that “every woman can breastfeed” cause harm to both mothers and babies. Thank you, Adrienne, for your submitting your eloquent and powerful story. I’ve excerpted your story below, but posted it in its entirety here. I hope that by reading it lactivists, lactation consultants, obstetricians and nurses can learn to be more knowledgeable and compassionate.

I found out I was pregnant with my first child in January of 2008. Despite being only 19 years old at the time I knew from the start that I wanted to breastfeed her. I asked my doctor about my breasts, they aren’t like other women’s breasts. One is long and tube shaped (kind of like a golf ball in the end of a tube sock); the other is prepubescent flat; my areolas are huge in proportion to the rest of my breasts. I was told that all breasts make enough milk, no matter what the size or shape.

My labor with her wasn’t how I had imagined. Never in my wildest dreams did I think it would be so hard. At the 21 hour mark I got my epidural; I had been begging for the epidural since hour 8 or 9 but was told I couldn’t have it because they didn’t want to “stall” my labo. She was born “sunny side up” and I tore badly and hemorrhaged. I barely remember seeing her for the first time, let alone holding her or breastfeeding her. She was supplemented with formula from the start and after a few weeks I gave up, thinking that I wasn’t successful at breastfeeding because I just didn’t try hard enough (I really didn’t try that hard at all).

The hospital staff and my OB were extremely supportive of me. My daughter’s doctor was a different story. During her 8 week appointment he asked me if I was still breastfeeding. I told him I had stopped breastfeeding two weeks prior when I had a second hemorrhage. He was aghast. He told me “you should go back to breastfeeding, it’s not too late, just cut out the bottles! You’ll love it, she’ll love it, and putting her needs over your feeling tired is what being a mom is all about”. I was crushed.

My daughter grew normally and rarely got sick until just after her first birthday. She started getting recurrent infections and would frequently lose weight (10-15% of her body weight at times). She was tested for every condition under the sun. Every test came back normal. During this time I received a few comments along the lines of “if you had breastfed her, her immune system wouldn’t be so weak”. These comments NEVER came from her care team, the staff at the children’s hospital .

In December 2012 I found out that I was expecting my second child. This time I was 100% committed to breastfeeding, I convinced myself that my son wouldn’t go through what his older sister went through, that if I breastfed him he wouldn’t get sick the way she did. My pregnancy with my son was complicated. I went into preterm labor at 29 weeks. Thankfully, the doctors and nurses were able to stop my contractions. I went into preterm labor several more times, but my son stayed put until 39+4.

Labor with my son, Harrison, was the complete opposite of labor with my daughter. My labor was 4 hours, start to finish. I didn’t hemorrhage this time and I immediately had skin-to-skin time, he latched like a champ and breastfed for the first time about 20 minutes after he was born. I just knew that this time things would be different, and I would be able to give him the strong immune system that I didn’t give my daughter.

Before we were discharged the pediatrician told us that had lost just under 10% of his weight and was mildly jaundiced. He assured me that he probably lost the weight because he was jaundiced and to wake him up to feed every 2 hours, round the clock.

We went home on a Saturday and the public health nurse came for a weight check the following Monday. He had lost another two ounces. She assured me that it can be normal for jaundiced babies to take a while to gain back to their birth weight and that my milk was just late coming in. He was having enough wet and dirty diapers (barely) so she said to just stay the course.

A few days later I was concerned because he looked more jaundiced to me so I took him to his doctor. They tested him and his bilirubin levels were in the 280s (μmol/L). His doctor gently suggested that I think about supplementing Harrison’s feeds with formula. I pleaded with his doctor to let us try a little longer and his doctor reluctantly agreed, but I had to bring Harrison back to retest his bilirubin levels every second day.

During this time I was completely convinced that I was doing something wrong. I saw the lactation consultant almost every second day trying to perfect his latch, I pumped after every feed, I chugged water like it was going out of style, I took supplements, I tried everything and nothing worked. Still, I plowed forward, blind to the fact that my son was suffering because of my desire to exclusively breastfeed him.

At his three week appointment he was still 4oz below his birth weight, he was dehydrated and his fontanel was sunken, he never cried (he didn’t have the energy), and his bilirubin levels were still in the 280s. He was starving. His doctor sat me down and said that I had to either start supplementing immediately or we needed to admit Harrison for IV hydration. I cried harder than I ever had before as I gave him that first bottle.

I started looking online for a reason why and I stumbled across the blog “Diary of a Lactation Failure”. Suddenly it all made sense. I had every marker for IGT [Insufficient glandular tissue, explanation and pictures here]. Every single one. I went back to the lactation consultant and asked if I had IGT; yes, she had thought that for quite some time. To her credit she was amazingly supportive. She told me that supplementing didn’t mean that I couldn’t have a breastfeeding relationship with my son. She gave me the tools to make a homemade SNS [supplementary nursing system], and recommended domperidone. I was on the maximum dose, but it didn’t do much to increase my supply. I also found the IGT and Chronic Low Milk Supply support group on Facebook, that resource has been the most helpful of all!

During those three weeks I was told by everyone (except for the hospital lactation consultants) that I should be pumping more, that I just needed to put him to the breast more often, that it was because I gave him a paci, that it was because I had an epidural, that whatever I do, I should NOT supplement. Everywhere I turned the message was the same: I just wasn’t trying hard enough. I felt guilty for starving my son while trying to exclusively breastfeed him and I felt guilty for supplementing with formula.

I had joined a few mainstream breastfeeding support groups on Facebook; the “support” I received was downright abusive at best and dangerous at worst. If I asked a question about how to maximize supply with IGT, they’d tell me to go somewhere else, that I was “fear mongering”, and that I didn’t belong in their group if I supplemented with formula. Their scary advice was suggesting that I take donor milk from strangers on the internet, because surely that was better than the “poison” I was feeding him. Several women suggested that I make my own formula using goat’s milk, chicken broth, raw egg, and some other ingredients, because apparently a recipe given to me by an untrained stranger on the internet containing raw egg was better than formula.

Now I realize that the people propagating the idea that if you have been unsuccessful at breastfeeding then you’re simply not trying hard enough are dead wrong. If only those women could have spent 24 hours on my schedule. My son had to be fed every two hours. After breastfeeding without, and with, the SNS I would pump for 20 minutes. Then I would clean my pump parts and prepare the SNS for the next feed. Each feeding session took about 1.5 hours; I only had thirty minutes between each session to sleep

I kept up that rigorous schedule for months. I felt like it would have been selfish for me to back off, that it didn’t matter how tired I was (emotionally, mentally, and physically). One day when my son was six or seven months old, my daughter broke down crying. She asked why I never spent any time with her anymore and why I didn’t love her anymore. My desperation to exclusively breastfeed had not only hurt my son, but it had hurt my daughter; not only had I been blind to my son’s suffering, I had also been blind to my daughter’s.

The message from lactivists is that breastfeeding makes you a good mom and not breastfeeding makes you an inferior mom; this message that made it difficult for me to see the damage I was causing to my children in my quest to exclusively breastfeed my youngest. If breast really is best, then it shouldn’t hurt the baby you are trying to feed or your older children. So, if it was hurting my children, maybe breast isn’t always best after all. Maybe what is best is dependent on the situation.

This realization was incredibly liberating for me. I stopped pumping the day my daughter broke down, and everyone was a lot happier for it. I still breastfed and I still used the SNS, but I also began bottle feeding my son so that I could share feeding responsibilities with other family members. I was able to give my daughter the time she deserved and I was able to give myself the time I deserved. The realization that exclusively breastfeeding (or relentlessly striving for exclusive breastfeeding when circumstances beyond your control make it impossible) wasn’t what was best for my family opened me up to the idea that maybe it isn’t always what is best for other families either.

I have learned so much from trying to breastfeed and the struggle to come to terms with the fact that my body just can’t make enough milk. I have learned that I am irreplaceable as my children’s mother because no one can love them like I do, no matter how much milk I do or don’t make. I learned that a mother’s reasons for choosing formula or breastfeeding are absolutely none of my business, and I don’t get to judge whether or not their decision is “valid”.

I have also learned that, while breastfeeding is natural and wonderful, it is not perfect. Breastfeeding doesn’t always work perfectly and that’s ok too. My breastfeeding relationship with my son may not be “perfect”, but it is perfect for us.

I’ve speculated before on the unique challenges facing contemporary advocates of natural parenting. When your identity revolves around parenting choices for babies and small children, what happens when those children grow up, and, inevitably, away from their mothers?

Choices like unassisted birth aren’t parenting choices; they’re parental identity choices. Unassisted birth doesn’t benefit babies. Indeed this video of an unassisted homebirth inadvertently demonstrates how and why homebirth increases the risk of neonatal death. They are forms of performance art and babies are just bit players in the mothers’ starring performances.

For unassisted birth advocate and lactivist Rixa Freeze, her extended series of performance art pieces is coming to an end.

So tell me I have something to look forward to. Because I thinking of growing older and aging and getting wrinkles and health problems (okay, maybe some of this is a long way off!) and my kids getting bigger and none of it seems interesting. What I’m trying to say is: having newborns and babies has been, for me, the Best Thing Ever and I don’t know if anything else can make up for the loss of that part of my life.

I understand “baby lust.” My husband originally wanted two children and I wanted four … so we compromised on four.

Despite all the physical work and the lack of sleep, infancy is a magical time. With each of my four children it was simultaneously the same and different. The same because it’s always like watching a flower bloom, unfolding and acquiring greater beauty every day; but different because each child is unique and although they start off looking very similar, their emerging personalities prefigure the fact that they are very different individuals.

What I learned, however, is that each stage has its own magic. There’s nothing else like watching a toddler acquire language, learning to say, “I love you!” as well as “You’re not the boss of me!” There’s nothing else like the primary school years when you are your child’s hero and teacher, introducing new ideas and skills, and watching your children run with them. There’s no joy like the joy of watching your child embrace the family traditions you loved as a child; no joy like your child hitting a Little League home run, dancing at a ballet recital, winning a formal debate; no joy like a child opening a longed for holiday gift that you were able to provide. Of course, there’s no worry like the worry that your child is being teased at school, no disappointment like a child who isn’t chosen for the travel team, no fear like the fear when they drive independently for the first time.

They are people, separate individuals with skills, talents, hope, fears, and dreams, not walking, talking validations of your own parental choices.

In my view, the most important gift a mother can give her children is loving them for who they are, not how they make her feel about herself.

The role of a mother is not use her children as a form of identity, a validation of her personal choices, a piece of performance art redounding to the greater glory of the mother herself. When you decide to have children, you are no longer the star; you are a supporting character, an important one to be sure, but not the main character. One of the greatest problems with the current incarnations of natural childbirth, lactivism and attachment parenting is that the children aren’t even characters; they’re just props. And when they can no longer serve as props, the mother cannot see any joy or purpose in them.

Mothering, when done right, is a series of losses. First you lose the “inside baby” when the baby is born. You lose the incredible physical closeness when they learn to crawl, then walk, then run on their own. When they head off to school, you lose the comfort that you know everything that ever happens to them. As they grow older, you lose the ability to make everything better, to solve any problems, meet any need. Eventually you lose being needed itself; they become independent adults. A good mother always works herself out of a job.

Unfortunately for Rixa, her identity appears to be bound up with unassisted homebirth and breastfeeding. She is apparently having trouble figuring out who she is if she can no longer define herself by them.

One of the hardest parts of being a mother is recognizing that your child is a separate person and does not exist to validate you or your choices. Ideally, a mother should acknowledge that from the very beginning, but Rixa should know that it is never too late to start.

If only babies could vote, the world would be a very different place.

Babies can’t vote, nor can they agitate for political goals; midwives and politicians can. Hence the otherwise inexplicable decision to change the UK homebirth guidelines to promote the economic well being of midwives and the National Health Service (NHS) ahead of babies lives.

Why is it inexplicable? Because homebirth is no safer than it ever was, yet according to the BBC:

The National Institute for Health and Care Excellence (NICE) said home births and midwife-led centres were better for mothers and often as safe for babies…

… [T]he new guidelines state 45% of women are at extremely low risk of complications and may be better off giving birth elsewhere…

It said women should be offered the choice of a home birth, an obstetric unit in hospital, a midwifery unit next to a hospital or a midwifery unit in the community.

That’s not what NICE said back in 2006:

Birth outside a [physician] led unit is consistently associated with an increase in normal vaginal births, an increase in women with an intact perineum and an increase in maternal satisfaction. The quality of evidence available is not as good as it ought to be for such an important health care issue, and most studies have inherent bias. The evidence for standalone midwife led units and home births is of a particularly poor quality.

The only other feature of the studies comparing planned births outside [physician] units is a small difference in perinatal mortality that is very difficult to accurately quantify, but is potentially a clinically important trend. Our best broad estimate of the risk is an excess of between 1 death in a 1000 and 1 death in 5000 births. We would not have expected to see this, given that in some of the studies the planned hospital groups were a higher risk population.

At the time, there was evidence that the government, which had already been promoting midwife led units and homebirth in an effort to save money, tried to pressure NICE to change its report before publication. According to an article in the July 2, 2006 issue of The Sunday Telegraph:

NICE’s draft guidance, which included a recommendation for all pregnant women to be told of a “trend towards a reduction in perinatal mortality” in hospitals, was submitted to the Department of Health nearly a fortnight ago.

Several days later – and ahead of its publication on June 23 – it was altered by Andrew Dillon, chief executive of NICE, after concerns were raised by the Department of Health. To the fury of his own experts, who felt that their message was being diluted, the wording was changed to: “There may be a risk of lower perinatal mortality” in hospital.

A source told The Sunday Telegraph: “There was an angry phone call between Andrew Dillon and representatives of the guideline development group.

“Concern over the safety of mothers and babies in midwife-led units was watered down. Many of the group felt this was totally unacceptable, but, because they are bound by confidentiality clauses, they cannot speak out publicly.”

Even then, it did not stop the government from forging ahead with promoting money saving over the well being of babies.

Five years later, in July 2011, I wrote a piece about the issue for The Times of London after Anthony Falconer, President of the Royal College of Obstetrician Gynecologists claimed that pregnant women “should no longer think of hospital as the default option when giving birth.”

At the time, there was no evidence that homebirth in the UK was as safe as hospital birth, and no evidence that homebirth saved money. There still isn’t, but that hasn’t stopped the political pressure and in the interim, the government came up with a fig leaf, The Birthplace Study.

Did the Birthplace Study show that homebirth in the UK is safe. No, it did not.

… [T]here was a significant excess of the primary outcome in births planned at home compared with those planned in obstetric units in the restricted group of women without complicating conditions at the start of care in labour. In the subgroup analysis stratified by parity, there was an increased incidence of the primary outcome for nulliparous women in the planned home birth group (weighted incidence 9.3 per 1000 births, 95% confidence interval 6.5 to 13.1) compared with the obstetric unit group (weighted incidence 5.3, 3.9 to 7.3).

That’s especially disturbing when you consider that the eligibility requirements for the Birthplace Study were much stricter than the actual eligibility requirements for homebirth as currently practiced in the UK.

Fast forward to yesterday, when a new NICE report was issued. A cynic might imagine that the result was pre-ordained since the chair of the group, obstetrician Susan Bewley, is a long time homebirth advocate.

And, indeed, Bewley concluded what she has concluded before:

Susan Bewley, Professor of Complex Obstetrics at King’s College London, who chaired the group responsible for developing the updated recommendations said: “Midwives are highly capable professionals and can provide amazing one-to-one care to pregnant women in labour, whether that’s in a woman’s own home, a midwife-led unit or a traditional labour ward.

“Some women may prefer to have their baby at home or in a midwife-led unit because they are generally safer – that is their right and they should be supported in that choice. But, if a woman would prefer to have her baby in a hospital because it makes her feel ‘safer’, that is also her right. Giving birth is a highly personal experience and there is no ‘one size fits all’ model that suits all women.

“What’s important is that women and their families are given the most up-to-date information based on the best available evidence so that they can make an informed decision about where the mother gives birth to her child.”

You can find the complete 839 page report here.

On what evidence did Bewley and colleagues rely to declare that homebirth is safe?

Fifteen studies (reported in 16 papers) were included in this review (Ackermann-Liebrich et al., 1996; Birthplace in England Collaborative Group, 2011; Davis et al., 2011 and 2012; de Jonge et al., 2009; de Jonge et al., 2013; Dowswell et al., 1996; Hutton et al., 2009; Janssen et al., 2002; Janssen et al., 2009; Lindgren et al., 2008; Nove et al., 2012; Pang et al., 2002; van der Kooy et al., 2011; Woodcock et al., 1994; Blix et al., 2012).

One of the studies is a pilot randomised controlled trial conducted in England (Dowswell et al., 1996). Three of the included studies are prospective cohort studies; these were conducted in England (Birthplace in England Collaborative Group, 2011), Switzerland (Ackermann-Liebrich et al., 1996) and Canada (Janssen et al., 2002). The remaining 11 studies are retrospective cohorts carried out in 8 different countries: England (Nove et al., 2012), The Netherlands (de Jonge et al., 2009 and 2013; van der Kooy et al., 2011), Sweden (Lindgren et al., 2008), USA (Pang et al., 2002), Canada (Hutton et al., 2009; Janssen et al., 2009), Australia (Woodcock et al., 1994), New Zealand (Davis et al., 2011 and 2012) and Norway (Blix et al., 2012).

How many of these studies involved a prospective trial in the UK? One and ONLY ONE, and by amazing coincidence, it is the Birthplace Study.

All of the above is just a long form version of a simple story. The government of the UK has been promoting homebirth as a cost saving measure since the mid-2000’s when there was no evidence that homebirth in the UK was safe or cost effective. They commissioned the Birthplace Study to slice and dice the data to provide a fig leaf, and lo, and behold, in 2014, with a long time homebirth advocate chairing the group, and relying only on the Birthplace Study, they finally produced the result that dovetailed with the government’s recommendations.

So the bad news is that the well being of babies has been sacrificed to political expediency. There is good news, though.

The good news is that the NICE guidelines appear to have zero practical significance. Despite the fact that the government has been promoting homebirth for nearly 10 years, the homebirth rate has fallen 20% in the past 4 years and now stands at 2.3%.

The new NICE guidelines are penny wise and £ foolish. They provide intellectual cover for the government, and they pander to midwives, but they don’t help babies or mothers, and they won’t save money.

The primary problem that the UK maternity system faces is an appalling level of care that results in a high stillbirth rate and an seemingly endless series of scandals where babies die in hospitals because of midwives’ promotion “normal birth” over babies’ well being. The NICE homebirth recommendations may generate favorable press for homebirth advocates, but they have no practical significance beyond proving, as if further proof were needed, that political power leads to bad healthcare decisions.