Lack of data is one of the things that is hampering us most in providing effective guidance and care during the COVID-19 pandemic. Perhaps nowhere is that more obvious than in the care of pregnant women who are ill with coronavirus at the time of delivery.

Fortunately, medical journals are rushing data online as fast as becomes available. Today JAMA Pediatrics published the latest data on newborn early onset COVID-19, Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China.

Here are the highlights:

– Babies can be infected with COVID-19 at the time of birth but it is unclear whether the virus was transmitted in utero or during delivery.

– The transmission rate is relatively high at 9%.

– The babies experienced only mild illness.

The authors described the 3 cases:

Patient 1 was born at 40 weeks’ gestation. The delivery was by cesarean delivery because of meconium-stained amniotic fluid and confirmed maternal COVID-19 pneumonia. On day 2 of life, the infant experienced lethargy and fever, with unremarkable physical examination results, and was moved to the neonatal intensive care unit. A chest radiographic image showed pneumonia … Nasopharyngeal and anal swabs were positive for SARS-CoV-2 on days 2 and 4 of life and negative on day 6.

Patient 2 was born at 40 weeks’ and 4 days’ gestation by cesarean delivery because of confirmed maternal COVID-19 pneumonia. He presented with lethargy, vomiting, and fever… A chest radiographic image showed pneumonia. Nasopharyngeal and anal swabs were positive for SARS-CoV-2 on days 2 and 4 of life and negative on day 6.

Patient 3 was born at 31 weeks’ and 2 days’ gestation by cesarean delivery because of fetal distress and confirmed maternal COVID-19 pneumonia. Resuscitation was required. The infant’s Apgar scores were 3, 4, and 5 at 1, 5, and 10 minutes after birth. Neonatal respiratory distress syndrome and pneumonia confirmed by chest radiographic image on admission resolved on day 14 of life after treatment … Nasopharyngeal and anal swabs were positive for SARS-CoV-2 on days 2 and 4 of life and negative on day 7.

In all cases, strict infection control procedures were in place during delivery. So how did the babies become infected? They got the virus from their mothers either in utero or during delivery itself:

Because strict infection control and prevention procedures were implemented during the delivery, it is likely that the sources of SARS-CoV-2 in the neonates’ upper respiratory tracts or anuses were maternal in origin. Although 2 recent studies1,2 have shown that there were no clinical findings or investigations suggestive of COVID-19 in neonates born to affected mothers, and all samples, including amniotic fluid, cord blood, and breast milk, were negative for SARS-CoV-2, the vertical maternal-fetal transmission cannot be ruled out in the current cohort.

The authors recommend rigorous screening and infection control measures:

… [I]t is crucial to screen pregnant women and implement strict infection control measures, quarantine of infected mothers, and close monitoring of neonates at risk of COVID-19.

Unfortunately this study can’t tell us whether strict separation of newborns from infected mothers is necessary because every baby in the study was separated.

The bottom line is that newborns can and do get infected when mothers are ill at the time of birth. That raises the possibility that temporary separation of mother and baby could prevent serious illness. We need more data before we can know for sure.

Your money or your life!

Many Republican politicians believe that is the choice we face. They are arguing to end social distancing restrictions in order to bolster the faltering economy.

I understand the sentiment. All along I have been more worried about the economic impact of COVID-19 than the medical impact. Yes, I fear the disease, too. Even mild to moderate cases sound horrible and it’s not something I wish to endure. But it won’t be a victory if we survive the virus only to starve in a Great Depression.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Ending restrictions won’t allow us to forfeit our lives instead of our money; it would force us to forfeit both![/perfectpullquote]

Yet a premature end to social distancing restrictions, far from providing a boost to the economy, will be the worst of all possible worlds. We will pay with our money AND our lives.

We’ve all heard about flattening the curve. That refers to the massive increase in the numbers of coronavirus cases that have been occurring and will continue to occur over the coming months.

It’s illustrated like this (from The New York Times):

The same number of cases occur under the blue curve as under the red curve, just over a longer period of time. Let’s imagine that both curves represent a million cases of illness each. Why does that matter if both curves mean the same number of people get sick overall?

The longer time period is crucial because it means that our healthcare system won’t be overwhelmed. Therefore, although the number of cases of COVID-19 is the same in both scenarios, the number of deaths will be much smaller over the longer time period since we will be able to adequately care for everyone who becomes ill.

But there’s another curve which we need to bend and that has received less attention, but is just as critical. We aren’t fated to have a million cases (or more!); we could reduce the number to half a million, a quarter of a million or less. It’s possible to reduce the number of cases overall by limiting the ability of the virus to spread. That’s what happened in China. They didn’t merely slow the spread of coronavirus, they stopped it.

How? Their program of social distancing was far more rigorous than ours. The government monitored every individual and forcibly isolated those who showed signs of the disease. They segregated them from the rest of society until they recovered and could no longer transmit the virus. They literally ended the epidemic.

This graph provides the best illustration of the choice we currently face. It is taken from the Financial Times and I have highlighted the trajectory of coronavirus cases in the US.

The graph uses a logarithmic scale to show the number of cases of COVID-19 over time in each individual country. The advantage of a logarithmic scale is that it illustrates exponential increase as a straight line; the steeper the line, the faster cases are increasing.

If you follow the trajectory of China, you can see that initially the number of cases of coronavirus were doubling every other day. In other words, the disease was spreading very rapidly. But then China began its aggressive quarantine of whole cities. Shortly thereafter, the curve begins to bend. Cases were doubling every 3 days instead of every 2 days. As Chinese policies became even more restrictive, the increase in new cases dropped even more dramatically, first to doubling every week and then longer, then no new cases at all.

Now look at the trajectory of US cases. We are still in the phase where cases are doubling every other day. And we can see an ominous development. The US trajectory has crossed the Chinese trajectory. In other words, although China began to bend the trajectory of disease increase at day 17 of their epidemic, we have failed to do the same. Despite the efforts we have undertaken thus far, as onerous as they have been, we have not yet changed the rate of spread of the virus.

In fact, the US now has the dubious distinction of being the country with the worst rate of increase in disease cases, worse than Italy — which is foundering — and worse than China. A democratic country cannot institute the draconian measures put in place in China, but Italy has finally begun to bend their curve by basically locking down the entire country.

The restrictions we have faced in the US to date — burdensome as they are and economically destructive as they are — have not yet allowed us to exert control over the spread of the disease. And until we do exert control, it will get much, much worse. The pandemic will hit us harder than any other country.

What does that mean for prospects of getting back to normal in the next few weeks? It means that it is literally impossible. Sure, we can reduce restrictions so workers can go back to work, but those workers will fall ill in massive numbers, basically shutting down the economy due to illness instead of keeping it shut down due to government restrictions. We will face the worst of all possible worlds: an economic collapse coupled with massive rates of illness and death.

Contrary to what many Republican politicians would have you believe, ending restrictions won’t not allow us to choose forfeiting our lives instead of our money. Ending restrictions would force us to forfeit our money AND our lives.

That’s not a choice; it’s a death sentence.

I’ve received quite a few private messages asking whether homebirth is a better option than hospital birth in the age of coronavirus.

Let me start by acknowledging that I don’t know. No one knows; our lack of testing means that we don’t know how prevalent the virus is in the population or how likely a person is to catch it from another person. We also don’t know if coronavirus poses special risks to pregnant women and newborns although for safety’s sake, we must assume it might.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Homebirth midwives are providers, too. They are at much higher risk than average of having and transmitting the virus.[/perfectpullquote]

Since I don’t know, I can only list the pros and cons as I see them.

COVID-19 INFECTION RISK

Pro: There is no question that hospitals themselves are very high risk areas for COVID-19 transmission. They are filled with people who are severely ill and doctors and nurses who have been exposed to the virus repeatedly. That said, it is important to remember that hospitals are always full of sick people, so strenuous efforts are made to isolate labor and delivery as well as the postpartum floors from the rest of the hospital. The safest place within any hospital is almost always labor and delivery and the postpartum floors.

Con: midwives are healthcare providers, too. Unless they have stopped seeing all their other patients, they are at much higher risk than average of having and transmitting the virus. Moreover, they are unlikely to have access to the personal protective equipment that would reduce their risk. Keep in mind that a pregnant woman could have the virus already and SHE could pose a significant risk to her baby.

Con: If you need to transfer emergently during labor or after birth, you will be exposed to EMTS and emergency room personnel, the people who have the greatest risk of having been exposed to the virus and potentially exposing you and your baby to it.

INTERVENTIONS

Pro: Homebirth dramatically reduces your risk of unnecessary intervention.

Con: Homebirth dramatically increases the risk of death for baby and mother due to lack of necessary interventions.

COMPLICATIONS

Pro: There are no pros. Homebirths do not reduce the risk of complications; they increase the risks that complications will lead to brain injury for the baby or even death for the baby or mother.

Con: There is no access to an operating room for emergency C-section, no access to blood transfusions for hemorrhage and no access to the people who can perform advanced resuscitation and intubation of a baby who is born not breathing.

Con: Complications can often be prevented with early recognition and intervention. Homebirth midwives boast that they are experts in normal birth; they leave unsaid the fact that they are NOT experts in childbirth complications and often don’t recognize when they are developing.

Con: In the US (but not Canada, the Netherlands, the UK etc.) there is a second class of “midwife” known as certified professional midwife. They are not real midwives, merely lay people whose “education” is typically only a correspondence course. They lack the education and training of ALL other midwives in the industrialized world and they fail to meet the international standards of midwifery. They are barely better, and in some cases worse, than no midwife at all. They have NO training in managing serious childbirth and newborn complications. That’s why their death rate in much higher than midwives in other countries.

ACCOUNTABILITY

Pro: There are no pros.

Con: Homebirth midwives in the US, particularly CPMs, lack both malpractice insurance and accountability. If something goes horribly wrong, there is no one to sue and no way to hold them responsible for their errors.

THE BOTTOM LINE

There is one undeniable pro to homebirth in the age of COVID-19. It almost certainly lowers your risk of exposure to the virus compared to hospital birth but ONLY if you don’t need to transfer to the hospital. Your risk is not low, however, since your midwife is at high risk of carrying the virus.

There are a lot of cons but none greater than the fact that in the US, homebirth dramatically increases the risk of neonatal brain injury and death.

On balance, it seems to me that the risks of homebirth outweigh the risks of hospital birth, but other women may reach different conclusions and make different choices and that is their right.

Lactation professionals lie and babies die!

Now they’re lying about coronavirus and babies, providing reassurance that may not merely be false; it may be deadly.

NO ONE KNOWS whether it is safe for an infected mother to breastfeed her baby!

Why do lactation professionals lie? Because they’ve forgotten about their ethical responsibilities. They are so obsessed with protecting breastfeeding they have forgotten they’re supposed to be protecting BABIES.

The result: while breastfeeding rates at hospital discharge have risen dramatically, the purported benefits have never been seen and the risks of brain injury and death have risen dramatically.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Lactation professionals are lying if they claim breastfeeding with coronavirus is safe. No one knows![/perfectpullquote]

Lactation professionals have lied for decades:

– Breastfeeding saves lives? There is zero evidence that breastfeeding saves lives in industrialized countries; there are only mathematical models that have never been validated.

– Breastfeeding prevents serious illness? No, breastfeeding reduces the risk of colds and episodes of diarrheal illness, but every other claim has been debunked or is based on weak evidence that isn’t corrected for confounding variables.

– Breastfeeding saves healthcare dollars? No, breastfeeding has become the leading cause of newborn re-hospitalization at a cost of hundreds of millions of dollars each year.

Most egregiously, lactation professionals lie about the risks of breastfeeding and that’s why babies have died:

– Insufficient breastmilk is rare? No, it’s common, especially in the early days after birth, affecting up to a third of first time mothers.

– Severe newborn dehydration is rare? No, the rate for babies of first time mothers is 223 per 100,000 births. That sounds small until you consider that it’s DOUBLE the rate of sudden unexpected infant death (SUID).

– Jaundice is nothing to worry about? Over 90% of cases of kernicterus (severe jaundice causing brain injury) occurs in exclusively breastfed infants.

– Newborn stomach size is only 5 ml? No, it’s 4X higher.

– Formula ruins the breastfeeding relationship? No, early judicious formula supplementation prevents complications and INCREASES the odds of extended breastfeeding.

Now lactation professionals are lying about breastfeeding and coronavirus and their arrogance may kill babies yet again.

NO ONE KNOWS whether it is safe for a woman to breastfeed if she is infected with coronavirus.

Let me say it again: NO ONE KNOWS!

NO ONE KNOWS whether coronavirus can be transmitted through breastmilk. While the existing evidence is reassuring it is also paltry. There are too few cases to draw any conclusions.

NO ONE KNOWS the risk of a nursing mother transferring coronavirus to her infant through respiratory droplets. It’s almost certainly quite high.

NO ONE KNOWS the risk to the baby of coronavirus itself. The Chinese experience was that the disease was mostly confined to older people, but the European and American experience has shown that coronavirus can and does sicken young people.

NO ONE KNOWS whether women who are infected will have antibodies to coronavirus in their breastmilk. It’s certainly possible, since the antibodies that are most likely to pass in breastmilk, IgA, can include antibodies to respiratory illnesses. But the bulk of antibodies produced by mothers in most diseases (IgG and IgM) don’t pass to infants through breastmilk.

What should we advise women about coronavirus and breastfeeding? No one knows and any lactation professional who tells you differently is not being honest.

When no one knows, the ethical obligation of medical professionals is to lay out the risks and benefits HONESTLY. Providing false reassurance is UNETHICAL.

When no one knows, medical professionals are forced to create protocols to prevent worse case scenarios (baby getting profoundly ill from coronavirus) because the opposite, letting babies get hurt, is UNETHICAL.

When no one knows, MOTHERS should be allowed to choose once they have been honestly informed of the risks and benefits.

It is possible that breastfeeding is the very best thing that an infected mother could do for her baby, but it is also possible that it is the very worst. NO ONE KNOWS!

And until we do know, breastfeeding professionals who offer false reassurance are lying and babies may die as a result.

We live in the age of coronavirus and it’s time to ask a critical, but uncomfortable question: should breastfeeding mothers switch their babies to exclusive formula feeding?

It should be up to individual mothers, but here are some important factors to keep in mind.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Should breastfeeding mothers switch their babies to exclusive formula feeding?[/perfectpullquote]

1. Without a diversity of sources, babies are excruciatingly vulnerable when breastmilk dries up.

Those who formula feed can get formula at their supermarket, their pharmacy, from stores like Walmart and Target, from Amazon and even from the manufacturer directly. Breastfeeding infants are restricted to the manufacturer only and if she gets sick and or hospitalized, they can starve!

2. Coronavirus is transmitted by respiratory droplets.

Therefore, women who become ill with coronavirus spew the virus over their breastfeeding infants, putting them at risk for illness.

3. Is there a breastmilk shortage? Probably not yet, but it’s a real possibility as more women become infected!

Should breastfeeding mothers worry? Of course! I hope I’ve done my part to make you scared out of your mind!!

*****

If you read this far, you’re probably wondering what is going on.

It’s simple: I’m copying lactivists who are trying to incite panic around formula.

There are always people who view a massive tragedy as an opportunity for personal gain. Consider the Tennessee brothers who hoarded hand sanitizer so they could gouge consumers on Amazon. They were off to a highly profitable start when Amazon noticed and shut them down. Facing state investigation, they decided to donate their stock.

Amazingly, lactivists (like the homebirth midwives I wrote about last week) view the pandemic as a marketing opportunity.

I kid you not! At a moment when each of us should be doing our utmost to reassure others that we will get through this extraordinary hardship together, lactivists are aggressively promoting the notion that there is a formula shortage.

There is no shortage of formula. It is easily available online and in most grocery stores, supermarkets and other retailers. But lactivists are so aggressive in their attempts to scare mothers that formula companies have had to publicly respond to deny that there is, was or will be a shortage.

Why would lactivist create and propagate such a vicious falsehood?

Two reasons: punishment and projection.

Lactivists seem to have a deep, abiding, ugly need to harass formula feeders.

That’s what’s behind periodic calls to make formula prescription only.

Requiring a prescription for infant formula is a form of shaming. How dare a woman imagine that she is entitled to determine how her own breasts are used? She should be required to abase herself in order to feed her baby the way she thinks is best for her baby, herself and her family.

It’s cruel, but it is far outstripped in cruelty by the current attempts to incite fear of a formula shortage.

For example, this “public service announcement” on Facebook:

If you breastfeed like a real mom, you wouldn’t have to worry about the formula shortage.

Or this lactivist who claims she is hoarding formula to sell it:

And THIS ladies is why breastfeeding is a vital part of life as a mammal. IT’S FREE WAY HEALTHIER AND IF YOU WAS EDUCATED ON IT PROPERLY and NOT LAZY & SELFISH those very who actually CAN’T do it would be fine

Or this lactivist:

Actually during this time of formula shortage breastfeeding can save a babies lives. I’m actually going to relactate so I don’t have to worry about formula anymore

I doubt she stopped breastfeeding, but the truth is that relactation after complete weaning is usually very difficult, if not impossible, and almost never produces enough to fully nourish a baby.

Lactivists are cruelly trying to use the deadly pandemic to punish women who formula feed by frightening them about supply, but there’s something else going on:

Lactivists are projecting!

They are the ones who are worried about their babies’ supply because they might get sick and not be able to provide enough or — if they become critically ill — any breastmilk. They subconsciously fear that THEIR babies are the ones who might suffer and reassure themselves by inciting other women to worry.

The ugly truth is that lactivists promoting rumors of formula shortages are no different from the Tennessee brothers who thought they could make a buck by price gouging on hand sanitizer. In this time of international crisis, when everyone should be helping everyone else, lactivists care only about victimizing others!

I spend a lot of time writing to, for and about people who are profoundly cynical regarding medicine, science and pharmaceutical companies. Some are sure that doctors are useless, if not harmful. They feel free to ignore expert scientific advice (e.g. climate change) and they are absolutely certain that Big Pharma provides nothing that has value beyond making a profit.

Now all of us, including the cynical, are in the midst of a global crisis that will ONLY be treated and solved by healthcare, medications/medical devices and ultimately vaccines.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]What do you think of doctors, scientists and Big Pharma now?[/perfectpullquote]

I’d like to ask the cynical: what do you think of doctors, scientists and Big Pharma now?

What do you think of doctors now?

Still think they care only about themselves? Then why are they working flat out in hospitals, exposing themselves to a virus that could be just as deadly for them as it is for you?

Still think they’re arrogant? Then why are they the first to admit that they don’t know much about the novel coronavirus? Why are they telling anyone who will listen that they have no specific medications to treat it, not enough ventilators to care for the most severely affected patients and no vaccines to prevent it?

Still think they only provide services for profit? Then why are they caring for anyone who is ill, regardless of ability to pay?

What do you think of scientists now?

Still think it’s okay to ignore their warnings? Then why did the countries who responded immediately and aggressively manage to “flatten the curve” so their healthcare systems aren’t overwhelmed? Why is it that China, a country that ruthlessly instituted every public health recommendation, has managed to contain the epidemic when others cannot?

Still think their work is esoteric and impractical? Then how did they manage to sequence the COVID 19 genome in only a few weeks, the first step to understanding how to get this pandemic under control?

Still think we don’t need basic science research? Would it change your mind to know that scientists had been developing a vaccine for coronaviruses in preparation for future epidemics but had their Federal funding cut and had to give up? Imagine how many things would be different now if a vaccine existed or were far along in clinical trials. We would not be facing a mounting death toll, our economy would not be grinding to a halt, we would not be stuck in our homes because our only tool of prevention is social distancing.

What do you think of Big Pharma now?

Still think their products exist only for profit? If you get very sick are you planning to refuse the antiviral medications that might help you recover faster? If you have severe difficulty breathing will you refuse the ventilator that would keep you alive?

Still think vaccines are ineffective? Then why doesn’t Big Pharma simply announce they have a coronavirus vaccine? Who would be able to tell the difference if vaccines don’t work anyway?

Still think Big Pharma shouldn’t have special legal protections to induce them to produce a vaccine that — because it will never be perfect — will end up spawning lawsuits that make the production unprofitable? An effective vaccine against COVID 19 could end the pandemic in days, not the weeks or months we are looking at now.

How fast do you want it developed? Do you want Big Pharma to spend years testing it and refusing to release it until they satisfy themselves that it won’t cause them to lose money from lawsuits? Or do you want them to bring it to market as soon as reasonably possible with the understanding that a small number of people may be harmed?

Still deeply cynical about doctors, scientists and Big Pharma? Who do you think will save you if not them?

There is no such thing as virginity. It is not a physiological concept. It is a social construct that reflects an obsession with female purity, virtue and honor. It is deeply misogynist.

There is no such thing as gut virginity, either. It is not a physiological concept but a social construct that reflects lactivists’ obsession with infant purity and maternal virtue and honor.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]It’s a tactic for controlling women’s behavior.[/perfectpullquote]

Lactivists have created and promoted the notion of gut virginity for the same reason that men created the notion of female virginity. It’s a tactic for controlling women’s behavior. The lactivist insistence on harm from formula supplementation — any amount, at any time, for any reason — was fabricated to keep women from using formula.

Consider sexual virginity:

There is nothing physiologically different in a man who has had his first sexual intercourse and one who has not. In women, there can be a minor physiological change, the tearing of the hymen, but many women do not experience that. Nevertheless, the hymen has come to represent the concept of virginity although there are many ways to have sex without changing it. There are even cosmetic surgeries that aim to recreate the semblance of a hymen to allow women to claim spurious virginity.

There is no such thing as virginity in the animal kingdom. Some members of a species are sexually mature and receptive; they have sex. Others are not; they don’t have sex. There is no self-imposed waiting period between becoming sexually mature and engaging in sex. There is no purity, virtue or honor being protected by abstinence.

Virginity isn’t physiological, it’s transactional. It is a way for men to characterize the products on offer in the marriage market. Women’s virginity is prized by men because it prevents cuckholding, reflects the masculine horror of raising another man’s child as his own, asserts ownership over women and allows fathers and prospective grooms to evaluate the “worth” of a woman.

How about gut “virginity”?

There’s nothing physiologically different in a baby who has had formula. There are no macroscopic or microscopic changes to any aspect of its body.

But wait! What about the microbiome?

The microbiome, the bacterial content of the infant gut, is a subject about which we know very little beyond the fact that it is exists. We have literally no idea what proportion of what organisms the infant microbiome is supposed to contain. We have literally no idea of the significance of individual variation: does it reflect a substantive difference or merely a diversity of normal like eye color or hair color. We have literally no idea whether any differences in the infant microbiome between breastfed and bottlefed infants has any impact on anything, let alone short term or long term health.

No matter. The infant gut microbiome in gut “virginity” has come to play the role of the hymen in sexual virginity. It is viewed as a marker of an infant’s “purity” and a mother’s honor and value. Both serve the same purpose; it’s a method of controlling women’s behavior. Hence it is referenced and mythologized in the same way as sexual virginity.

The young women who has sex just one is forever defiled and she has “lost” her virginity. The baby who gets “just one bottle” of formula is forever impure and has lost its gut virginity.

Both concepts are self-serving fictions.

A woman’s virtue is not in her vagina. It is in her intellect, character and talents. Whether or not she is a sexual virgin tells us nothing meaningful about her or her worth.

A mother’s virtue is not in her breasts. It is in her caring and emotional connection to her infant. Whether or not her baby is a formula virgin tells us nothing about her, her worth or her love for her child.

Yesterday I wrote about a new paper in which breastfeeding researchers were forced to acknowledge risks and complications they have denied for years.

Yet despite the litany of life threatening risks, despite the fact that judicious formula supplementation improves the odds of exclusive breastfeeding and despite the fact that a study of formula supplementation followed by exclusive breastfeeding showed no difference in the gut microbiome, the breastfeeding researchers still recoil from formula in horror.

That’s because the “virgin gut” isn’t really about breastfeeding and babies; it — like the concept of sexual virginity — is about controlling women.

The title is dull, Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥ 35 Weeks, but the admissions within are blockbusters. Simply put, breastfeeding researchers have been forced to acknowledge that everything the Fed Is Best Foundation and I have been writing for years is true:

• Insufficient breastmilk is common
• Serious, life threatening dehydration can result
• Wet diapers are NOT a reliable indicator of hydration status
• Insufficient breastmilk is not “misperceived”
• Low blood sugar can threaten babies’ brain function
• Serious, life threatening jaundice can result from insufficient breastmilk
• Judicious formula supplementation does not harm breastfeeding
• Pacifiers bans have no basis in science
• The Baby Friendly Hospital Initiative has led to babies harmed by falling from or being smothered in mothers‘ hospital beds

There’s only one glaring omission: an apology for denying these facts for years.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Lactation researchers admit that insufficient breastmilk is COMMON![/perfectpullquote]

The authors, includIng stalwarts of the contemporary lactivist movement like Lori Feldman-Winter, MD, MPH, Joan Younger Meek, MD, MS, IBCLC, Alison M. Stuebe, MD, MSc, strive for a tone of dispassion, but their conclusions are bombshells.

1. Insufficient breastmilk is common, especially in the early days after birth.

Most, but not all, women experience lactogenesis II, referred to as “milk coming in,” by 72 hours post partum. In the Infant Feeding Practices Survey II, 19% of multiparous women and 35% of primiparous women reported milk coming in on day 4 or later…

Occasionally, a woman does not experience lactogenesis II and only produces small volumes of milk (prevalence 5%–8%).

So insufficient breastmilk isn’t rare; it doesn’t affect only a small proportion of infants and mothers. It is very common and can affect more than one third of first time mothers in the early days after birth!

2. Serious, life threatening neonatal dehydration can result

… characterized by lethargy, restlessness, hyperreflexia, spasticity, hyperthermia, and seizures, with an estimated incidence of 20 to 70 per 100 000 births and up to 223 per 100 000 births among primiparous mothers.

This is exactly the clinical picture exhibited by Christie del Castillo-Hegyi’s son leading to permanent brain injury and Jillian Johnson’s son Landon, leading to his death. Lactivists have repeatedly discounted their stories and found reasons to blame them for the tragic outcomes. Here they are the same outcomes in black and white with no mention that mothers are to blame.

3. Wet diapers are NOT a reliable indicator that a baby is receiving adequate breastmilk.

Importantly, elimination patterns during the first 2 days of life are neither sensitive nor specific as measures of infant intake. Infants may be voiding and stooling despite insufficient intake …

4. Women are not “misperceiving” insufficient breastmilk.

One of the cruelest lactivist deceptions has been the refusal to believe women who report insufficient breastmilk, claiming they are “misperceiving” the situation.

[A] prospective cohort study of 280 mother-infant pairs examined elimination patterns in relation to excessive weight loss (>10%) … The strongest association was with ,4 stools after 72 hours or maternal perception of delayed lactogenesis II.

5. Low blood sugar can cause permanent brain injury.

The threshold for neonatal glucose that is associated with neurotoxicity is unclear… In one cohort study, treatment of asymptomatic newborn hypoglycemia to maintain blood glucose levels >47 mg/dL had no effect on cognitive performance at 2 years; however, at 4.5 years, there were dose-dependent concerns regarding visual motor and executive function, with the highest risk in children exposed to severe recurrent (≥ 3 episodes) hypoglycemia.

6. Severe jaundice is potentially deadly complication of insufficient breastmilk.

…[P]athologic hyperbilirubinemia resulting from insufficient breastfeeding, sometimes referred to as breastfeeding jaundice, is better defined as suboptimal intake jaundice. In the United States and Canada, it is recommended that all neonates undergo bilirubin risk screening at least once before hospital discharge… This approach has led to a decrease in severe pathologic hyperbilirubinemia …

7. Judicious formula supplementation makes successful breastfeeding MORE likely.

In a pilot RCT (N = 40), early limited formula supplementation for infants with ≥ 5% weight loss increased exclusive breastfeeding at 3 months postpartum.

8. Pacifier bans have no basis in science.

…[T]here is insufficient evidence to limit pacifiers and other artificial nipples.

9. The Baby Friendly Hospital Initiative — mandating rooming in and closing well baby nurseries — has harmed babies.

Since the initial implementation of the BFHI, safety concerns have emerged, including case reports of inadvertent bed-sharing, suffocation, falls, and increased risk of neonatal jaundice.

The bottom line is that breastfeeding researchers have been forced to admit that EVERY risk of breastfeeding that the Fed Is Best Foundation and I have been highlighting for years is real, true and harming babies on an ongoing basis.

Whom should you trust on vaccines, an expert or a quaxpert? And how can you tell the difference?

1. An expert has formal education in the topic at hand, while the quaxpert has none.

This has several important implications. It means that the expert has been exposed to a wide variety of evidence and viewpoints. He or she tends to be familiar with ALL the scientific evidence, not merely cherry picked studies that the quaxpert has never read and wouldn’t understand if she did read. It means that the expert is fully conversant with any major controversies in the field, has thought a lot about them, has read both sides, and has come to a decision. The quaxpert generally views the controversy as a dichotomy between those with formal education and quaxperts, who claim to have personal experience.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Quaxperts take no responsibility for recommendations.[/perfectpullquote]

2. An expert understands both science and basic statistics and can reach an independent opinion about the existing scientific evidence. A quaxpert has to take the word of someone else.

An expert is giving you an expert opinion. A quaxpert is giving you the opinion of someone he likes with all the attendant drawbacks of relying on empirical claims just because you like who made them.

3. An expert recommends what’s good for YOU. A quaxpert recommends what’s good for himself.

Experts rarely have a one-size-fits-all recommendation. Even in the case of vaccination for childhood diseases, which ALL experts (pediatricians, immunologists, public health officials) recommend, there are exceptions and every effort is made to find out if your child is one of the exceptions. That’s why you are asked about your child’s allergies, previous reactions to vaccinations, and family history of vaccine reactions. The quaxperts generally have one-size-fits-all recommendations; you should do what the quaxpert did, regardless of how your circumstances differ from those of the quaxpert.

4. Experts change their recommendations based on new scientific evidence. Quaxperts never change recommendations regardless of what the scientific evidence shows.

For example, over the years experts have changed the formulation of vaccines, the timing of vaccines and the need for boosters. Quaxperts were opposed to all vaccinations 100 years ago and they’re opposed to all vaccinations now even though the scientific evidence has shown repeatedly that vaccines are extraordinarily effective and extraordinarily safe. It makes no difference to quaxperts what the evidence shows because quaxperts rely on unchanging beliefs systems, not science.
Experts also acknowledge when they are wrong. Consider this year’s flu vaccine. The experts, the same people who counseled everyone to get the vaccine, publicly announced that this year’s vaccine has only limited effectiveness. Although you should still get the vaccine, you should understand that it is not as effective in some years as in others. When was the last time a quaxpert acknowledged that he or she was wrong about a fundamental claim?

5. Experts take responsibility for their recommendations. Quaxperts ignore you, or even blame you when THEIR recommendations cause more harm than good.

It’s difficult to overstate the importance of this point. Experts pay a price if they are wrong. You can take action against them, and they are well aware of that. It is in THEIR best interest — professional, financial and personal — to give you state of the art recommendations based on the latest science. Nothing ensures accuracy like having skin in the game.

In contrast, quaxperts take no responsibility for their recommendations. If they are wrong, YOU pay the price and they just keep giving out the same bad advice. They win if you listen to them, regardless of whether listening to them harms or kills you or your child.

Sure, they dress it up by pretending that you are taking responsibility for your health by listening to them, but you are taking the SAME amount of responsibility for your health when you listen to your doctor. The difference is not in your level of responsibility; it’s in THEIRS.

The deadly coronavirus pandemic is a disaster for individuals, a disaster for public health and a disaster for the economy.

But one group is positively excited about the calamity: homebirth midwives.

Why? They view the tragedy as an awesome marketing opportunity.[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]One group is positively excited by the coronavirus calamity.[/perfectpullquote]

The Midwives Alliance of North America is all over it. Their latest blog post is The Impact of Coronavirus on Community Birth. MANA Vice President Sarita Bennett is positively gleeful about the deaths and economic havoc:

While thinking I’d much rather spend my time planning how to spread community midwifery, I realized how the two – virus and midwifery – may impact each other… It only makes sense for out of hospital birth to become the safer choice for the majority of people in a crisis like this.(emphasis in original)

To my knowledge, coronavirus has spread around the world so quickly because it is COMMUNITY acquired, NOT hospital acquired. Therefore, people face the greatest threat of getting coronavirus in routine interactions in daily life.

…[T]he best way for people to protect themselves and others is stay home and out of public places, making quarantine an important strategy to limit exposure. Is our best advice to pregnant/laboring people to travel out into the public, to a hospital full of those very people they need to stay away from? With medical facilities full of the sick and those caring for the sick, the benefits of staying home for physiologic childbirth and successful lactation become even more obvious.(emphasis in original)

Can you get coronavirus in a hospital? Healthcare workers have gotten it that way, but they spend their days dealing with the secretions of the very ill. As of yet, there have been no reports of individuals contracting coronavirus by visiting the hospital for some other condition.

So there’s NO REASON to think that hospital birth would put women at greater risk of getting coronavirus than riding the subway to get there. No matter, it’s a marketing bonanza.

What’s going on here?

Homebirth midwives adore homebirth. Very few women feel the same way.

Except in the Netherlands, homebirth is (and has been for decades) a fringe practice. Anything that engages 2% of the population or less is almost by definition a fringe practice. But maybe a deadly disease could spark increased interest!

Midwives are obsessed with homebirth for a number of reasons:

1. It is the natural end point of their obsession with promoting what they can do and demonizing what they cannot. They’ve gone from favoring the employment of midwives in maternity units, to midwife led units and birth centers. Homebirth is the logical next step, freeing them from any scrutiny by other health professionals.

2. It reflects the intellectually and moral bankrupt philosophy that the “best” birth is NOT the safest birth, but the birth with the least interventions.

3. It ensures that women cannot get effective pain relief.

4. It is a midwife full-employment plan. In contrast to a hospital based unit where one midwife can care for multiple women at a time, homebirth (in many countries) requires two midwives to care for one woman.

Lest you think that it is only American homebirth midwives who view coronavirus as a marketing opportunity, consider this tweet from British physician and homebirth advocate Susan Bewley who decorates her Twitter profile with her conceit that she is “speaking truth to power.”

Bewley is commenting on a Guardian article about midwives’ refusal to honor patient requests for epidurals.

I’m waiting for someone to write an article on the implications of coronovirus for birth & rediscover the place of birth recommendations…

Midwife Leah Hazard responds:

It would be so amazing if the pandemic encouraged more women to birth safely at home…

Amazing?

No doubt corona virus is a marketing bonanza for coffin makers, too, but at least they have the good sense to keep quiet about hoping to profit from deadly disease.