All anti-vaxxers share one very important thing in common.

Wait, let me amend that.

In addition to ignorance of basic science, statistics and logic anti-vaxxers share another important characteristic: they are ruled by fear!

Anti-vaxxers are afraid of anything they don’t understand and they don’t understand vaccines. They have chosen to band together and create an identity around that fear.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Anti-vaxxers are not victims of vaccines, merely victims of their own unreasoning fear.[/perfectpullquote]

Sure they tell themselves and others that their community is united by refusal to gullibly accept the assurances of experts, but they easily fall prey the unreasoning and unreasonable fear generated by gullibly accepting warnings from quacks and charlatans.

Imagine if our distant ancestors, the ones that anti-vaxxers believe they are emulating, had behaved in the same fearful manner.

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

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

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

Or much, much later:

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

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

Our distant ancestors could be forgiven for fearing innovations since they had no way to understand how they worked. Contemporary anti-vax advocates, in contrast, are ignorant because of their own actions. The knowledge of how vaccines work and their safety is available to anyone who cares to learn. But anti-vaxxers prefer to remain ignorant and afraid; indeed they proudly build their identity around their ignorance and fear.

In his first Inaugural Address, during the Great Depression, President Franklin Roosevelt famously said:

…[T]he only thing we have to fear is fear itself — nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.

Roosevelt was right. Unreasoning fear made the economic disaster worse and more prolonged. Guided by his wise counsel and bolstered by the government programs he created, the economy began to recover and people shook off the debilitating effects of fear.

In truth, the only thing anti-vaxxers have to fear is fear itself — nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat against disease into advance!

Unreasoning fear of vaccines and companies that produce them has allowed vaccine preventable diseases to claw back from the edge of extinction. The only effective way to protect ourselves from these diseases is to be guided by the counsel of experts in immunology, microbiology and public health. Only then can we shake off the debilitating effects of the nonsense peddled by the anti-vax movement.

Roosevelt also said this:

Men are not prisoners of fate, but only prisoners of their own minds.

Anti-vaxxers are not victims of vaccines, merely victims of their own unreasoning fear, the result of their ignorance of science and gullible acceptance of the nattering of quacks and charlatans.

People are dying, massive quarantines are in effect and the financial markets are reeling.

Why? Coronavirus.

After infecting tens of thousands in China, the novel coronavirus has reached dozens of other countries — at least 48 in total. Public health officials say it’s almost inevitable the illness will spread more extensively within the U.S. So what do we know about COVID-19, and how can we prepare for a broader outbreak? …”

It’s not easy to prepare when we aren’t familiar with the behavior of the virus. As infectious disease specialist Peter Hotez, MD explains:

Unfortunately, because this is a new virus agent, there’s more we don’t know than we do know. We think it’s highly likely that this virus is transmitted by what we call droplet contact. By that, somebody sneezes or coughs and releases micro -droplets into the air that either land on surfaces that people will touch with their hands and bring to their face, or the droplets will directly contact to the face, and they will rub that into their mucous membranes of their eyes and nose.

There is reason for concern:

However, the World Health Organization, Dr. Bruce Aylward, came out a couple of days ago, and he says he thinks that 2 percent number is real. And that’s a pretty significant mortality rate, because a typical seasonal flu, for instance, which still kills a lot of people in the United States, as the president pointed out last night, will kill around 0.1 to 0.2.

So we’re talking about something that is maybe 10 to 20 times more lethal than typical seasonal influenza. So, that’s really concerning, the fact that it’s so highly transmissible, and it has that high case fatality rate.

So I think we’re going to be — have to be — watch this very closely, especially in the United States in the coming weeks.

While the media is filled with medical experts attempting to get a handle on the virus and prevent transmission, notice who ISN’T being interviewed: no one in a responsible position is consulting anti-vaxxers and their charlatan “experts.”

Why?

The anti-vax movement rests on several fundamental premises, premises that its aficiandos can hold because they face no threat from the diseases vaccines are designed to prevent. These premises include:

Vaccine preventable illnesses were prevalent because of poor sanitation.
They weren’t that bad.
Natural immunity to disease is preferable to vaccine induced immunity.
Vaccines cause more health problems than they prevent.
Vaccines exist just to enrich pharmaceutical companies.

The potential coronavirus crisis gives us a window into what the crises of smallpox, diphtheria, polio, rubella and other diseases were all about: devastating diseases, easily transmissible, with no effective treatment and no way to prevent them.

While coronavirus may turn out to be less deadly in the US than it has been in China, no one is suggesting that it isn’t that bad.

There’s no evidence that it can be prevented by sanitation. Sure hand washing can help but the disease is transmitted by droplets sneezed out by those who are ill.

Natural immunity couldn’t save the hundreds who have already died and there’s some evidence that massive natural immune response leads to death in affected individuals.

Doctors and scientists are racing to develop a vaccine because they know that an effective vaccine will save lives on a massive scales.

People are desperate for a vaccine.

Are you afraid of coronavirus as it heads to the US? That’s how people felt about smallpox, diphtheria, polio and even the flu a century ago. They could strike anyone, at any time, and permanently maim or kill.

That’s why scientists developed vaccines.

If a safe vaccine could be developed, would you refuse it and take your chances with coronavirus? Probably not, right?

Do you think that coronavirus is a minor problem being hyped solely for the benefits of the pharmaceutical companies that will ultimately produce a vaccine? No? Then perhaps you can understand why a century ago people didn’t feel that way about smallpox, diphtheria, polio or even flu vaccines.

We are watching a viral scourge unfold in real time. I have no doubt that we will eventually develop a vaccine for coronavirus. We’ve done it many times before; there’s no reason we can’t do it again. And I have no doubt that if vaccination for coronavirus becomes routine in order to protect the health of future generations, there will eventually be anti-vaxxers wailing that the vaccine is unnecessary, that the disease is caused by poor sanitation, that “natural” immunity is better than vaccine induced immunity and that it was a scam developed to benefit pharmaceutical companies.

In the meantime anti-vaxxers might want to consider that their fundamental premises — which obviously don’t apply to coronavirus — don’t apply to other vaccine preventable diseases, either.

The new lactivist tactic is so vicious it defies belief.

It was pioneered by anti-vaxxers who target the mother of a child who has died of a vaccine preventable disease, claiming the she is lying or that she killed her child. Now lactivists are applying it to mothers whose babies have been brain injured or died as a result of insufficient breastmilk.

Consider Australian lactivist Lisa Bridger. She experienced her 15 minutes of fame back in 2018 when she boasted about breastfeeding her 7 year old autistic son.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Bridger is pathetic![/perfectpullquote]

She received many negative and even hateful comments. You might think she would be sympathetic to mothers who deal with the brain injuries and deaths of babies due to insufficient breastmilk. You would be wrong.

In an effort to discredit Jillian Johnson, whose baby Landon died 8 years ago, Bridger posted this on Landon’s birthday.

Baby Landon’s story is commonly posted by the fed is best foundation stating that he died from starvation from insufficient breastfeeding. The problem is that this babies coroner’s report doesn’t say this. Landon sadly was born unwell. He was dehydrated at birth after a difficult delivery. He was admitted to intensive care and found to have pneumonia…

None of that is true so how does Bridger feel confident in making such odious claims? She pretended to be a researcher and ordered the coroner’s report on another woman’s baby.

no I’m not personal involved. I saw the original story many years ago, it was then blasted all over via the fed is best foundation. Many people called out the inconsistencies within the two stories. Jillians original, Christie’s version, and what really happened. As a researcher I was interested, I chose to request, payed for the publicly available copy and have since done intensive research into it…

She’s not a “researcher” and perhaps that explains why she thoroughly misunderstands what she read. The coroner’s report COMPLETELY SUBSTANTIATES Jillian’s story; Landon died from insufficient breastmilk.

How do you read a report when multiple causes of death are listed?

According to the CDC guidelines in Medical Examiners’ and Coroners’ Handbook on Death Registration:

Part I is for reporting a chain of events leading directly to death, with the immediate cause of death (the final disease, injury, or complication directly causing death) on line (a) and the underlying cause of death (the disease or injury that initiated the chain of events that led directly and inevitably to death) on the lowest used line…

If an organ system failure (such as congestive heart failure, hepatic failure, renal failure, or respiratory failure) is listed as a cause of death, always report its etiology on the line(s) beneath it (for example, renal failure DUE TO Type I diabetes mellitus or renal failure DUE TO ethylene glycol poisoning).

Therefore, the coroner’s report on Landon’s death should be read as follows:

Hypoxic-Ischemic Encepalopathy (brain damage)

DUE TO

Cardiac Pulmonary Arrest

DUE TO

Hypernatremic Dehydration (dehydration accompanied by high sodium levels)

Nowhere does it say that Landon was born dehydrated or with high sodium levels. If such a thing were possible (I’ve never heard of it), it would be described as “congenital” and it’s not.

In fact, Landon’s tragedy is typical for cases of brain injury and death caused by insufficient breastmilk.

There are increasing reports on hypernatremia, a potentially devastating condition, in exclusively breastfed newborn infants… A total of 115 reports were included in the final analysis. Breastfeeding-associated neonatal hypernatremia was recognized in infants who were ≤ 21 days of age and had ≥ 10% weight loss of birth weight… In addition to excessive weight loss (≥ 10%), the following clinical findings were observed: poor feeding, poor hydration state, jaundice, excessive body temperature, irritability or lethargy, decreased urine output, and epileptic seizures…

Why does Bridger engage in such reprehensible behavior? For the same reason anti-vaxxers harass loss parents: narcissistic rage.

Wikipedia describes it best:

…Narcissistic rage is the uncontrollable and unexpected anger that results from a narcissistic injury – a threat to a narcissist’s self-esteem or worth. Rage comes in many forms, but all pertain to the same important thing, revenge. Narcissistic rages are based on fear …

My disgust for Bridger’s behavior is leavened by pity. Imagine the abject fear that drives her and other lactivists; their fear that they have been wrong all along about the perfection of breastfeeding and their rage that an innocent child dared to die in a way that exposes the hollowness of their ideology and fragility of their egos.

Bridger is pathetic and I’m not just talking about her fundamental ignorance of medicine, science and statistics.

I wish this situation were rare, but it’s not.

I wish this were a joke, but it deadly serious.

I wish were about mom’s intuition, but it’s really about her ego.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]The baby is suffering to bolster his mother’s ego.[/perfectpullquote]

Does anyone have experience with slow-gainers or failure to thrive? I’m desperate for any advice/ information you have. What is “normal” weight gain by 3 months of age? My son is 3 months old today and is only 8oz over his birth weight. His pediatrician is now getting concerned. He “highly suggested” that I supplement with formula. I don’t believe that is the solution since we don’t even know what’s wrong. I told him I would not be supplementing and that he needs more time to grow. Now that I’m calm …. My mother’s intuition is saying we are missing something.

The baby was apparently 9lb 8oz at birth and has only gained 8oz in the three months since. This baby is STARVING.

He’s not meeting his milestones.

Why? Because he’s being STARVED.

It is difficult to comprehend the full depth of this child’s suffering. Imagine constantly being fed small amounts, never enough to satisfy. Imagine cannibalizing your body so you can feed (underfeed?) your growing brain.

It’s definitely a pride issue for me for sure. I had the natural birth. I gave him the best, healthiest welcome, Despite having so many negative feelings toward breastfeeding I still wanted that for him no matter the discomfort I would be in (past trauma). I feel like I did everything “right” just to come to this point of I think I missed something.

Yes, you missed something. You are letting your baby STARVE!

He is not a settled baby. He cries a very good portion of the day unless he is being fed…

Infants experience hunger as painful and profoundly distressing. Imagine the pain this baby experiences on a daily basis.

The mother insists that she has a plentiful supply that is moderate to extremely fatty. She gives no indication of what she thinks is “plentiful.” She says that he takes bottles of pumped milk from her mother while she is at work.

What would be the harm of supplementing with formula? The mother’s ego would take a hit. How do I know it’s about her ego? She writes:

100% natural 7 hour water birth, no vaccines for either of us, he never left my sight, uncomplicated delivery.

She’s absolutely sure of one thing: her baby’s profound and potentially deadly failure to thrive it can’t be her “fault.”

I’m aware that gaining 8 oz in 3 months is definitely room for serious concern. That’s why I feel like we’re missing something.

Yes, you’re missing the fact that you are STARVING your baby.

What needs to happen?

1. This baby needs to be hospitalized for a comprehensive evaluation and work up because he is suffering from profound malnutrition and his brain function and health are at risk.

2. The baby needs formula supplementation to get calories into him ASAP.

3. He needs weighted feeds to determine if he is receiving “plentiful” breastmilk as the mother claims.

4. If he is taking adequate volumes of fluid he may need special formula in order to digest what he is taking in.

5. If he is taking adequate volumes of fluid he needs metabolic and genetic testing to determine if he has an inborn error of metabolism that it is making him ill on breastmilk.

6. He needs evaluation for chromosomal syndromes that can impede both growth and development and might account for his constant crying.

The bottom line is that something is VERY wrong and this baby needs to be evaluated TODAY!

If the mother reads this, I have a message:

I BEG you to take your baby to the emergency room of the the closest university hospital you can reach as soon as you can! Forget about your ego. His brain and his life are at stake and you need to put YOUR BABY first!

Opponents are clear about one thing; women don’t understand the risks. They aren’t giving informed consent because they aren’t fully informed. Sure, they may be counseled about the major risks, the ones that could kill you, but deaths are rare. The other complications are so much more common. If women only knew of the myriad risks, they’d never choose it in the first place.

Opponents recommend more extensive counseling, preferably counseling that takes place long before the decision needs to be made. They helpfully offer books and websites as well as in person counseling about ALL the risks, not just the ones that doctors deign to mention.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Many lactivists, like many anti-choice activists, believe the ends justify the means.[/perfectpullquote]

Inevitably there has been a backlash against the opponents but the opponents claim the high ground with the retort: “Are you saying that there are NO risks?” Everyone knows that there are risks; opponents are providing a valuable service by carefully and extensively counseling women about the risks. Once women know, they will reject the choice.

Think I’m talking about anti-choice advocates who work tirelessly to prevent women from choosing abortion? Think again.

I’m talking about lactation professionals who work tirelessly to prevent women from choosing formula.

Consider the paper I wrote about yesterday. The lead researcher, graduate student Gemma Bridge, claims on The Conversation Some infant formula milks contain more sugar than soda drinks:

Some formula milks have double the sugar per serving than a glass of soda.

But that is a deliberate misrepresentation of what the authors found. Their OWN data shows that NO infant formulas have double the sugar per serving than the average glass of soda.

How did they arrive at their shocking “finding”? They disingenuously included milk drinks marketed to PRE-SCHOOLERS. I reached out to the Bridge on Twitter and she does not deny it.

It’s lie on par with the anti-choice lie that abortion causes cancer.

Tragically, neither lactivists nor anti-choice activists feel constrained by the truth. Reasoning that the ends justify the means, both groups routinely exaggerate and even fabricate “risks.” Seeking, above all else, validation of their personal philosophical beliefs, both groups struggle to convince women who would choose differently that those choices are wrong.

Both groups have zero regard for what happens to women (or babies!) once they make the choice. They care about women up to the moment that they are forced into the “correct” decision; whatever happens afterward to their physical or mental health must simply be endured by the women they have tricked.

Most of us can easily recognize the tactics of anti-choice activists for what they are, mendacious attempts to force women to make approved decisions. We should recognize the tactics of lactivists — including some breastfeeding researchers — for what they are, mendacious attempt to force women to breastfeed or feel guilty if they don’t.

Much of what passes for contemporary breastfeeding “research” is meant to demonize formula, not to accurately assess the risks and or tote up the trivial benefits of breastfeeding.

Consider a new paper is published in a journal of dentistry(?!). A cross-country exploratory study to investigate the labelling, energy, carbohydrate and sugar content of formula milk products marketed for infants is a perfect example of fake news.

What’s the difference between real news and fake news?

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]The authors present NO evidence the sugar content of infant formula dramatically exceeds that of breastmilk.[/perfectpullquote]

Real news attempts to inform while fake news attempts to manipulate people by playing on their emotions and often resorts to mistruths, half truths and outright lies to do so.

The lead researcher, graduate student Gemma Bridge, claims on The Conversation Some infant formula milks contain more sugar than soda drinks:

Some formula milks have double the sugar per serving than a glass of soda. That was the key finding of our global investigation into the sugar content of infant formula and follow-on milks…

The “key finding” is a bald faced lie!

Bridge breathlessly writes:

Our findings revealed that over half of the products contained more than 5g of sugar per 100ml.

I should hope so! The average sugar content of breastmilk is 7 gm for 100 ml. Any product that contains substantially less sugar is inadequate and possibly deadly for babies.

In support of their claims, the authors offer a chart in their paper. I’ve taken the liberty of adding the typical sugar content of both breast milk and soda to the author’s chart.

The red line represents the sugar content of soda and the purple bar represents the range of sugar content in breastmilk. Not only is there no evidence that the sugar content of formula dramatically exceeds the sugar content of breastmilk, there is no evidence that ANY formula has double the sugar content of soda.

So how did the authors come up with their “findings”?

1. The authors are not entirely honest about the sugar content of breastmilk.

According to a 2013 paper in the Pediatric Clinics of North America:

The macronutrient composition of human milk varies within mothers and across lactation but is remarkably conserved across populations despite variations in maternal nutritional status… [T]he mean macronutrient composition of mature, term milk is estimated to be approximately 0.9 to 1.2 g/dL for protein, 3.2 to 3.6 g/dL for fat, and 6.7 to 7.8 g/dL for lactose…

So the sugar content of breastmilk varies across mothers and time and ranges from 6.7-7.8 g/dL (100ml).

2. The authors are not honest about the sugar content of soda.

There are 39 gm of sugar in a can of Coca-Cola. That works out to 11 gm/dL. The authors, however, use the misleading comparison of an iteration of Fanta Orange that has been specifically redesigned to remove sugar.

As part of our commitment to reduce the calories in some of our most popular drinks Coca-Cola European Partners changed the recipe for Fanta Orange in 2006 – it now contains 33% less sugar and calories than the previous recipe.

3. The authors are not honest about standards for infant formula.

According to Global Standard for the Composition of Infant Formula:

Data on the composition of human milk of healthy, well-nourished women can provide some guidance for the composition of infant formulae, but gross composi- tional similarity is not an adequate determinant or indicator of the safety and nutritional adequacy of infant formulae.

Instead:

…[T]he adequacy of infant formula composition should be determined by a comparison of its effects on physiological (e.g. growth patterns), bio- chemical (e.g. plasma markers) and functional (e.g. immune responses) outcomes in infants fed formulae with those found in populations of healthy, exclusively breast-fed infants.

The authors have IGNORED the fact that international experts determine the optimal composition of formula based on outcomes, NOT slavish recapitulation of breastmilk averages.

4. The authors pretend products marketed to preschoolers are “infant” formulas.

They deliberately mislead by including milks that are NOT for infants.

Total carbohydrate (g/100 ml) ranged from 4.7 (ready-to-drink milk formula for 1–3 years, UK) to 13.5 (milk formula powder for 2–3 years, Cambodia)… Across product categories, the highest average total carbohydrate content, in this sample, was in powdered milk formula products aimed at infants aged 2–3 years (8.84 g/100 ml).

NO formulas for infants dramatically exceed the sugar content of breastmilk and NO formulas for infants have double the sugar content of soda.

The paper is just fake news designed to demonize formula … which probably explains why the authors couldn’t get it published anywhere besides a journal of dentistry.

Yesterday I wrote about the disabling flaw that renders meaningless nearly every study that purports to show the benefits of breastfeeding.

Most breastfeeding studies compare babies who are breastfed with babies who are not breastfed at a moment in time weeks or months after birth (3 months, 6 months, one year). But when we only look at breastfeeding status at a particular moment in time, babies who develop complications from breastfeeding will mistakenly end up in the formula group. If we want to know the difference between babies who are breastfed and those who are formula fed, we must place the babies who failed to thrive on breastfeeding in the breastfeeding group, NOT the formula group.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Breastfeeding, like homebirth, must be studied with intention to treat analyses.[/perfectpullquote]

How could we correct the disabling flaw? The same way we do in research on homebirth: we compare groups based on intention. Just as homebirth studies compare intended homebirths with intended hospital births, breastfeeding studies should compare intended breastfeeding with intended formula feeding. This is known as an intention to treat analysis.

What happens when we take intention into account? The purported benefits of breastfeeding disappear!

To my knowledge there is only one study that has explicitly taken intention into account, The best of intentions: Prenatal breastfeeding intentions and infant health.

The authors looked at more than 1000 women and categorized them based on whether they intended to breastfeed or not.

They noted:

…Approximately one-third of mothers who intend to exclusively breastfeed are able to achieve this goal. There are several exogenous factors that may prevent mothers from fulfilling their intentions. For example, biological barriers include low milk supply, pain, infections (mastitis), or clogged milk ducts. The baby may have a poor latch, be an ineffective nurser, or have food intolerances…

Those babies belong in the breastfeeding group, NOT the formula feeding group where nearly all studies on the purported benefits of breastfeeding put them.

The authors looked at three infant health outcomes: ear infections, respiratory syncytial viruses (RSV), and antibiotic usage in the infant’s first year. They found that women who intended to breastfeed had infants with better health outcomes REGARDLESS of how soon babies with breastfeeding complications were switched to formula.

What’s going on?

Breastfeeding in industrialized countries is socially patterned. Privileged women are far more likely to breastfeeding. It is privilege that leads to the purported benefits of breastfeeding, not breastfeeding itself.

To my knowledge there is no other intention to treat analysis of breastfeeding. But since breastfeeding is socially patterned, we can approximate intention to breastfeed by correcting for social-economic factors.

The 2014 study Is Breast Truly Best? Estimating the Effects of Breastfeeding on Long-term Child Health and Wellbeing in the United States Using Sibling Comparisons corrected for these factors by looking for the differences between breastfed and formula fed infants WITHIN families. When they did, there was no difference between breastfed and bottle fed babies.

Most studies of breastfeeding that correct for socio-economic factors yield similar results: the purported benefits of breastfeeding are markedly attenuated or disappear altogether.

There is another indirect way to account for intention to breastfeed vs. intention to formula feed. We can look at overall population statistics. For decades, lactation professionals have made detailed predictions of decreased infant mortality, severe morbidity and healthcare expenditures with rising breastfeeding rates. Though breastfeeding rates have soared in the US and other industrialized countries, NONE of those predicted benefits have occurred. One possible reason for this is that the benefits of breastfeeding are trivial.

Another possibility is that the purported benefits of breastfeeding are entirely offset by complications of breastfeeding. Exclusive breastfeeding has become the leading cause of newborn re-hospitalization leading to tens of thousands of re-hospitalizations each year at a cost of hundreds of millions of dollars. Aggressive breastfeeding promotion is literally making babies sick!

The bottom line?

Any study that claims breastfeeding has benefits but doesn’t use an intention to treat analysis is improperly done and therefore the results are deeply suspect.

That explains why the benefits of breastfeeding disappear when we correct for maternal socio-economic status and why the predicted benefits of increased breastfeeding rates have never come to pass.

Nearly all studies on the purported benefits of breastfeeding over formula feeding are meaningless.

Why?

Because the choice of the comparison groups is beset by a disabling flaw.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Babies who were breastfed but failed to thrive must be placed in the breastfeeding group, NOT the formula group.[/perfectpullquote]

Nearly all breastfeeding studies compare two groups of infants, those that have been breastfed and those that have not. Babies who were breastfed but failed to thrive are inappropriately placed in the formula feeding group, instead of the breastfeeding group where they belong.

To understand why that’s a critical problem, it helps to consider another example.

Imagine we are trying to determine the risks of homebirth. We can’t simply compare death rates of babies born at home to death rates of babies born in the hospital. That would lead to an erroneous outcome since many women who develop complications during homebirth are transferred to the hospital where the baby is ultimately born.

If we looked only at place of birth at the moment of delivery, we would erroneously include the homebirth complications in the hospital group. Homebirth would end up looking much safer than it is in reality. The appropriate comparison is women who intend to give birth at home and women who intend to give birth in a hospital.

How does that apply to breastfeeding studies?

Most breastfeeding studies compare babies who are breastfed with babies who are not breastfed at a moment in time weeks or months after birth (3 months, 6 months, one year). But when we only look at breastfeeding status at a particular moment in time, babies who develop complications from breastfeeding will mistakenly end up in the formula group. The appropriate comparison is women who intend to breastfeed and women who intend to formula feed.

If we want to know the difference between babies who are breastfed and those who are formula fed, we must place the babies who failed to thrive on breastfeeding in the breastfeeding group, NOT the formula group.

Sure, successful breastfeeding might be beneficial compared to formula feeding, but that’s something entirely different than claiming that breastfeeding is better than formula feeding. The truth could be the opposite: that when compared to breastfeeding (both successful AND unsuccessful), formula feeding is not merely beneficial, it is life saving. And, therefore, many mothers who are formula feeding are doing so because of the extraordinary benefits of formula.

The bottom line?

Studies that compare breastfeeding to formula feeding but put breastfeeding failures into the formula feeding group suffer from a disabling flaw that makes their results meaningless. In other words, nearly the entire literature that claims to show that breast is best shows nothing of the kind!

Natural childbirth advocates like to say that “there’s more to birth than a healthy baby.” Duh! No one ever said otherwise. That’s why epidurals and maternal request C-sections should be available to anyone who wants them. They’ve chosen a specific birth experience because there’s more to birth than a healthy baby; there’s pain relief and avoiding pelvic trauma among other things.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Where did this mother get the idea that the obstetrician wants to ruin her birth experience?[/perfectpullquote]

But a dead baby will ruin your birth experience every time.

Consider this post from a natural childbirth Facebook group:

Well, fired my doctor yesterday. I am currently 40+6.
I’m comfortable, healthy, perfectly fine. Baby is comfortable, healthy, perfectly fine.
But, according to my doctor, “at this point, it is pitocin or a c section” and I “need to just get used to the idea of pitocin”
She informed me she was stepping out to call L&D to schedule an induction, I got dressed and left.
I understand her games, and I’m not playing. She has never spoken to me this way and up until the point-made me believe she was supportive of my natural birth preferences. I have an amazing support team and doula. We are all on the same page.

Baby will come when baby is ready

Sure the baby will come eventually; it just might be dead when it arrives. And let me assure you, a dead baby will ruin your birth experience!

Preventing dead babies is the job of every obstetrician. It is hardly a game; it’s a sacred trust.

Where did this mother get the idea that the obstetrician wants to ruin her birth experience? From natural childbirth advocates, the same people who created the cultural construct of “birth experience.”

The conceit of the contemporary natural childbirth movement is that they are recapitulating birth in nature. Nothing could be further from the truth. In nature, a good birth experience was and remains a healthy baby born to a healthy mother.

Caroline Bledsoe and Rachel Scherrer are anthropologists who study the natural childbirth movement. In the chapter The Dialectics of Disruption: Paradoxes of Nature and Professionalism in Contemporary American Childbearing they explain the cultural construct of natural childbirth:

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

The mother refusing induction is taking the safety of her baby utterly for granted. She doesn’t know that every day beyond 39 weeks increases the risk of stillbirth.

Does that mean her baby is guaranteed to die? No, it means the risk of the baby dying is increased. It’s like refusing to put a baby in a car seat on a trip to the supermarket. The odds that the baby will die on the trip are small … but refusing to use a car seat makes them much higher than they would have been. The odds that this baby will die are also small, but by refusing a medically recommended induction the mother has made them much higher.

Bledsoe and Scherrer offer a critical insight into the thinking of mothers like these:

If nature is defined as whatever obstetricians do not do, then the degree to which a birth can be called natural is inversely proportional to the degree to which an obstetrician appears to play a role. The answer to why obstetricians are described with such antipathy thus lies not in the substance of what obstetricians do that is unnatural – whether the use of sharp incision. forceps, and medications that blunt sensation. or anything else- but in the fact that obstetricians represent a woman’s loss of control over the birth event.

…[I]t is not what obstetricians do that women find problematic but the fact that they are the people who step in when the woman is seen to have failed.

This mother hired her obstetrician, because she believed the obstetrician would keep her and her baby safe. But when the OB recommended induction, the mother rejected it because it embodied “failure” on her part. She failed to go into labor on her own.

Bledsoe and Scherrer understand what the mother does not:

… As we turn to the disruptions that preoccupy US middle-class women as they contemplate the birth of a child. it is vital to keep in mind both the dangers that reproduction can entail and the science that has allowed us to imagine as common sense a safe, uninterrupted, reproductive life trajectory.

Because there’s nothing like a dead baby to ruin a birth experience!

It’s confusing.

The UK, with an elaborate system for studying maternity care, publishes reams of statistics about stillbirths, perinatal mortality, infant mortality and maternal mortality through MBRRACE-UK, Mothers And Babies: Reducing Risk through Audits and Confidential Enquiries. Here’s the latest publication UK Perinatal Deaths for Births from January to December 2017.

In 266 pages, with dozens of tables and charts, they slice and dice the mortality statistics in a thousand different ways: by ethnicity, by socio-economic status, by hospital system, by post code. Yet there’s one critical statistic that is missing: death rates at home birth. In fact, I’ve been writing about homebirth in the UK since 2006, but to my knowledge the UK has hidden their homebirth death rates the entire time.

Why? It might have something to do with the fact that the government began promoting homebirth aggressively BEFORE they could show that homebirth was safe. The key study of UK homebirth, the Birthplace Study, began years AFTER the government promotion efforts.

Indeed, a cynical person might wonder if perhaps the statistics from UK homebirths that were occurring before the Birthplace Study showed that homebirth has an increased risk of perinatal death and the government was desperately searching for some way to make homebirth appears as safe as hospital birth.

It might have something to do with the fact that back in 2006, NICE (the National Institute for Clinical Excellence) reviewed the existing homebirth literature and concluded that homebirth increases the risk of perinatal death.

The report was quoted in The Telegraph, June 2006 before it was officially published:

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 only other feature of the studies comparing planned births outside [physician] units is a small difference in perinatal mortality … 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.

But the government wanted to promote homebirth and exerted pressure on NICE to change the report.

From The Telegraph, July 2, 2006:

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.

Think about that: in an effort to promote homebirth, the government suppressed the opinion of its experts that homebirth increases the risk of perinatal death.

The Birthplace Study itself was hardly the unalloyed success they were hoping for. The authors found that homebirth increases the risk of death, brain damage and serious neonatal injury.

They evaluated the results by creating a composite index of poor outcomes: intrapartum stillbirths, early neonatal deaths, neonatal encephalopathy [brain damage] meconium aspiration syndrome, brachial plexus injury, and fractured humerus or clavicle. Using this measurement:

… [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).

In other words, the risk of death and serious injury was nearly double in the homebirth group and that increase was seen mainly among first time mothers. Moreover, the criteria for inclusion in the study were far stricter than the actual UK criteria for homebirth. Only the lowest risk women were included in the study despite the fact that higher risk women are eligible for homebirth.

The Birthplace Study fails to answer the most important question that women have about homebirth: does homebirth AS PRACTICED in the UK increase the risk of perinatal death. That information is undoubtedly available. A government that tracks perinatal death rates by ethnicity, socio-economic status, health system and post code can track perinatal death rates by whether or not a birth was a planned homebirth.

So why is the UK hiding their homebirth death rate? I suspect that it’s because the government fears (or knows) that homebirth in the UK increases the risk of perinatal death substantially, even more than what the Birthplace Study shows.