It is a sad fact that women are the biggest fans by far of contemporary charlatanism. It’s true for astrology and tarot cards, and equally true for health quackery like reiki and homeopathy.

In the paper The appeal of medical quackery: A rhetorical analysis, pharmacists Widder and Anderson note that believers in quackery are likely to be female, spiritual, with lower perceived health and a “holistic” view of health problems.

Why do so many women embrace quackery?

The currently favored explanation is because healthcare providers have been notoriously unsympathetic to women’s health issues. That explanation is advanced by everyone from quack defenders like Jennifer Block:

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Belief in quackery has been RISING at the same time medicine has been taking women’s symptoms and suffering more seriously.[/perfectpullquote]

When we become empowered to learn more about our bodies, our instincts, our emotional landscapes and the connections therein, maybe we’ll begin to demand that our complex and (still!) mysterious physiologies are treated with respect, dignity, and humility in the realms of medicine and science.

to physicians fighting quackery like cardiac surgeon Nikki Stamp who wrote Gwyneth Paltrow’s ‘Goop Lab’ is horrible. The medical industry is partly to blame. in yesterday’s Washington Post.

…[M]edicine as a profession and a science has no doubt played a part in the genesis and growth of big wellness. For virtually the whole of its existence, medicine has disenfranchised women and, to varying degrees, continues to do so. Even as medicine has modernized with an emphasis on autonomy and resolving bias, it remains, at times, paternalistic and patriarchal.

But what if there’s another reason altogether? Perhaps women’s embrace of quackery is a direct results of their lack of education in math and science.

Don’t get me wrong; I’m NOT arguing that medicine is perfect. I’m well aware that there is a long and ugly history of medical paternalism in which women’s symptoms, pain and suffering have been ignored. But belief in quackery has been RISING in parallel to decreases in that paternalistic attitude.

Women now represent half of entering medical school classes and far more than half of physicians in fields like gynecology and pediatrics. Women are taking a greater role overall in the delivery of healthcare as a result of a rise in nurse practitioners and midwives. If belief in quackery were truly a response to practitioners who don’t understand and don’t care about women’s health concerns, it should be falling in the early 21st Century, not rising.

Perhaps women embrace healthcare quackery — and “other ways of knowing” — not because they are being ignored by mainstream providers, but because they don’t understand and therefore fear math and science.

Consider the issue of vaccinations. What do you need to know to understand the science around vaccines? In addition to education in immunology, you need a good grasp in three areas: the scientific method, statistics and logical thinking. Education and training in STEM (science, math, engineering and tech) provide students with a strong foundation in science, statistics and logical thinking and women are notoriously underrepresented in STEM

It’s no wonder then that women who lack grounding in science, statistics and basic logic imagine that the case for vaccines is nothing more than accepting the authority of experts. There is literally no way for them to apprehend the real arguments for the safety and efficacy of vaccines beyond taking someone else’s word for it. In truth, anti-vaxxers are more likely to be “sheeple” than the pro-vaxxers they criticize; they simply rely on favored quacks like Andrew Wakefield rather than legitimate scientists because they can’t tell the difference.

There’s another reason why women embrace healthcare quackery. Many healthcare quacks are women. Science is hard and quackery is easy. Scientific professions require rigor; quack professions require only credulousness. It’s hard to be a pharmacist; it’s easy to be an herbalist. It’s hard to be an orthopedic surgeon; it’s easy to be a chiropractor. It is much harder to become a physician than a nurse. It also a lot harder to be an obstetrician than to be a midwife. That’s reflected in the fact that physicians are far less likely than midwives and nurses to be taken in by and become purveyors of quack theories and remedies.

Maybe the solution to the current epidemic of belief in quackery is one that we should be pursuing in any case: encouraging and facilitating an increase of women in science, math, engineering and technology!

What do you do when you desperately want to believe in something and there is no scientific evidence to support it? You call it “other ways of knowing”!

What do other ways of knowing look like in practice?

They look like this:

Including the nonrational is sensible midwifery, by Jenny A. Parratt, and Kathleen M. Fahy, was published in the Australian midwifery journal Women and Birth. It has a simple premise and conclusion: many principles of radical midwifery theory are not supported by science. Rather than modify midwifery theory to reflect scientific knowledge, it is easier (and more lucrative) to rationalize ignorance and superstition by calling it other ways of knowing.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]“Other ways of knowing” rationlize ignorance and superstition.[/perfectpullquote]

It is striking how the language of the paper resembles that used in justifications of religious belief, the most popular of all “other ways of knowing”:

Much of life cannot be apprehended or comprehended on a purely rational basis… Consider, for example, the sensations that may arise when watching a sunset, hugging a loved one, hearing a bird’s song or delighting in a sense of bodily capability… Similarly a midwife’s ordinary practice of being with the woman can be experienced by the midwife in quite extraordinary — nonrational — ways…

The centrality of emotion is similar; beliefs that are not supported by scientific evidence are nevertheless valid because they help people feel better about themselves; interestingly, the “people” in question are not necessarily patients; they can also be practitioners or purveyors.

Experiencing the nonrational may include sensations of inner power and/or inner knowing… These experientially grounded, nonrational aspects of life have been described variously as mysterious, sacred, spiritual and intuitive… Experiences that are nonrational are experiences of unity and wholeness; …

And, of course, no discussion of other ways of knowing is complete with reference to the “soul”.

Our soul is our own particular organic expression of the spiritual milieu of nonrational power. The soul moves in parallel with spirit: thus soul is nonrational, ethically neutral and idiosyncratic… Through our soul we may interpret and experience the power of spirit in diverse and contrasting ways: e.g. liberating, oppressive, joyous, peaceful or challenging…

The central claim of the paper is that the inclusion of the non-rational is midwifery “enhances safety”, although the authors’ explanation seems to show nothing of the kind.

When the concept of ‘safety’ is considered in childbearing it can illustrate how insensible rationality can be and how negative consequences can occur. Safety is an abstract concept because it is difficult to define and can only be considered in general terms. Rational dichotomous thought, however, provides ‘safety’ with the following defining boundaries:
– ‘safe’ has a precise opposite called ‘unsafe’,
– every situation/person/thing must be either be safe or unsafe,
– a situation/person/thing cannot be both safe and unsafe,and
– it is not possible for a situation/person/thing to be anything
other than safe or unsafe.

The authors complain:

…What is deemed as safe is aligned with what is rational and what is unsafe is aligned with what is irrational. As irrationality is not acceptable this essentially forces the definition of safety to be thought of as ‘true’ even though it may not fit with personal experience and all situations…

For example:

…[W]hen a woman and midwife have agreed to use expectant management of third stage, but bleeding begins unexpectedly, the expert midwife will respond with either or both rational and nonrational ways of thinking. Depending upon all the particularities of the situation the midwife may focus on supporting love between the woman and her baby; she may call the woman back to her body; and/or she may change to active management of third stage. It is sensible practice to respond to in-the-moment clinical situations in this way… Imposing a pre-agreed standard care protocol is irrational because protocols do not allow for optimal clinical decision-making which requires that we consider all relevant variables prior to making a decision. In our view all relevant variables include nonrational matters of soul and spirit.

Evidently, even if the woman bleeds to death for lack of pitocin, the decision to “support love between the woman and her baby” is still the correct one because her “soul” is “safe”.

The authors conclude:

Being open to the nonrational in midwifery practice makes room for midwives to self-reflexively acknowledge aspects of themselves, such as their fears, in a way that does not interfere with their practice. During birth, making room for the nonrational broadens both midwives’ and women’s knowledge about trust, courage and their own intuitive abilities including the changing capabilities of bodies….

At least these midwives are honest, even if completely inane. A fundamental (perhaps, the fundamental) goal of other ways of knowing is to make purchasers and purveyors feel good about themselves. Coming face to face with the fact their cherished beliefs in homeopathy, anti-vax or radical midwifery are nothing more than ignorance and superstition makes believers feel badly about themselves.

Fortunately, there is a way for purchasers and purveyors of ignorance and superstition to feel better. Just call the beliefs other ways of knowing!

A piece in today’s Guardian asks the intriguing question: Is breastfeeding incompatible with American capitalism?

And while it reaches the right answer — yes, it is incompatible — it fails to note the right reason: breastfeeding is promoted so aggressively precisely BECAUSE it is incompatible with capitalism. La Leche League, the engine of contemporary lactivism, was started with the express intent of keeping women out of the workforce.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]La Leche League, the engine of contemporary lactivism, was started with the express intent of keeping women out of the workforce.[/perfectpullquote]

Journalist Brianna Bell compares what she was told about breastfeeding to the reality of breastfeeding.

…B]reastfeeding … was not as cost-effective as I had first believed…

There’s also an unspoken cost that many breastfeeding proponents neglect to mention: the cost of a mother’s time…

And that’s time that is taken away from paid work, forcing many women to choose between breastfeeding and working. There’s no contest since most women who work cannot survive without the income it provides.

The solution seems obvious to Bell: paid maternity leave.

I’m strongly supportive of paid maternity leave because both babies and mothers benefit from it. But there are two reasons why it is not the solution.

First, Bell fails to consider that the country with the LOWEST rate of breastfeeding in the world is the UK and it has a system of generous maternity leave. Would more women in the US breastfeed for longer if we had such a system? There’s no reason to think so.

Second, breastfeeding is promoted as aggressively as it is NOT because its benefits; in industrialized countries the benefits of breastfeeding are trivial. (Don’t believe me? The UK, the country with the lowest breastfeeding rate in the entire world, has one of the lowest infant mortality rates in the world.) It is promoted as aggressively as it is because contemporary lactivism is intended SPECIFICALLY to keep mothers out of the workforce.

That was the conscious plan of the founders of La Leche League, seven devout Catholic women who saw the promotion of breastfeeding as a way to keep mothers of young children from working and send them back home where they belonged.

In the book La Leche League: At the Crossroads of Medicine, Feminism, and Religion, Jule DeJager Ward explains:

[A] central characteristic of La Leche League’s ideology is that it was born of Catholic moral discourse on family life … The League has very strong convictions about the needs of families. These convictions are the normative heart of its narrative …The League’s presentations and literature carry a strong suggestion that breast feeding is obligatory. Their message is simple: Nature intended mothers to nurse their babies; therefore, mothers ought to nurse.

In the late 1950’s when LLL was founded, its members believed that if they forced women to choose between working outside the home vs. breastfeeding as “best” for their babies, mothers would choose breastfeeding. That may have been what happened in the beginning but for at least the last 40+ years, when forced to choose between working and breastfeeding, most women chose working.

That’s why lactivists persist in grossly exaggerating the benefits of breastfeeding far beyond anything supported by the scientific literature. That’s why they dream up ever more arcane “benefits” of breastfeeding (the microbiome! epigenetics!) as the substantive benefits are systematically debunked. And that’s why they have made breastfeeding ever more onerous: refusing to supplement, promoting bedsharing — a practice deadly to babies — and normalizing maternal exhaustion

These onerous restrictions dovetail with LLL’s original mission, to force women to choose between breastfeeding and working. The last thing lactivists want is to make it possible for women to do both. That’s why it is going to be a very long time before the US adopts universal, extended, paid maternity leave.

Breastfeeding as promoted by contemporary lactivists is incompatible with American capitalism … just it was designed to be!

The New York Times Op-Ed Who’s Afraid of Gwyneth Paltrow and Goop? by Elisa Albert and Jennifer Block is offensive for a variety of reasons.

It’s offensive because it is another example of a prestigious news outlet publishing alternative “facts.” It’s offensive because it sugar coats the rabid consumerism promoted by a profit driven corporation. And its claim that pseudoscience is feminist is particularly offensive to women because it is an insult to the memory of famous women scientists who struggled against the misogynistic belief that science and math are “too hard” for women and they are reduced to relying on intuition.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Women are just as smart as men, as mathematically gifted as men, and as capable of SCIENTIFIC reasoning as men.[/perfectpullquote]

This passage in particular devalues the women scientists and mathematicians who struggled against the suffocating misogyny of beliefs about women’s intelligence or lack thereof:

Throughout history, women in particular have been mocked, reviled, and murdered for maintaining knowledge and practices that frightened, confused and confounded “the authorities.” (Namely the church, and later, medicine.) Criticism of Goop is founded, at least in part, upon deeply ingrained reserves of fear, loathing, and ignorance about things we cannot see, touch, authenticate, prove, own or quantify. It is emblematic of a cultural insistence that we quash intuitive measures and “other” ways of knowing — the sort handed down via oral tradition, which, for most women throughout history, was the only way of knowing…

Seriously?

That’s an insult to the memory of Ada Lovelace whose mathematical feats laid the groundwork for the computer industry. Lovelace is known for her work on Charles Babbage’s Analytical Engine, publishing the first algorithm for use with the machine. She is rightly remembered as one of first computer programmers.

Lovelace encountered prejudice NOT because she resorted to feminine ways of thinking but because she dared master mathematics, a discipline that had been considered masculine.

It’s an insult to the memory of Marie Curie, the first woman to win a Nobel prize, the first person to win two Nobel prizes and the first person to win Nobel prizes in two different fields. She developed the theory of radioactivity, techniques to isolate radioactive isotopes and discovered two radioactive elements.

Curie encountered prejudice NOT because she resorted to feminine ways of thinking but because she dared master physics, a discipline that had been considered masculine.

It is an insult to the memory of Virginia Apgar. She developed the ubiquitously used Apgar score and is considered a pioneer in anesthesiology, teratology and neonatology.

Apgar encountered prejudice NOT because she resorted to feminine ways of thinking but because she dared master medicine, a discipline that had been considered masculine.

It is an insult to the memory of Rosalind Franklin whose pioneering efforts in deciphering the structure of DNA were hidden by men who couldn’t bear the thought that women were as capable of performing ground research as men.

Franklin encountered prejudice — and was nearly erased from the history books — NOT because she resorted to feminine ways of thinking but because she dared master X-ray crystallography, a discipline that had been considered masculine.

It is an insult to the memory of Frances Oldham Kelsey, one of the first women at the FDA (Food and Drug Administration) who subsequently was awarded the Presidential Award for Distinguished Service for refusing to back down from her insistence that thalidomide caused birth defects despite tremendous pressure from drug companies.

Kelsey encountered prejudice NOT because she resorted to feminine ways of thinking but because she dared to used science to refuse the importuning of the pharmaceutical industry, a profession that had been considered masculine.

But most of all, pretending that pseudoscience is feminist is insulting — and harmful — to the rising generation of women. We have enough trouble recruiting women into science, engineering and technology without other women insisting that all three are the purview of men and women should stick to “other ways of knowing.”

When we were children, my generation was told that science and math were “too hard” for women, and girls were steered away from physics and engineering toward professions like teaching and nursing. Women like me owe a deep debt to feminist pioneers who, often at great personal cost, paved the way for acceptance of women into every subject of study and every possible career.

They insisted — in the face of tremendous male resistance — that women are just as smart as men, as mathematically gifted as men, and as capable of conducting scientific research and making scientific discoveries as men. It is deeply insulting to their memories when women like Albert and Block portray science as male and pseudoscience as feminist.

It pretends to be transgressive but it promotes a thoroughly capitalist, rabid consumerism.

Because it’s really about money.

It venerates romanticized “traditional” wellness practices that not only were never practiced by our foremothers, but are thoroughly modern.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]In defending GOOP, Block and Albert imagine themselves as feminists, but they are fools fronting for a marketing machine.[/perfectpullquote]

Because it’s really about money.

It stresses feminist empowerment by perpetuating the misogynist belief that irrational thought is the special province of women.

Because it’s really about money.

It’s Gwyneth Paltrow’s GOOP and it’s pseudoscience in a dress, albeit a Prada dress.

That’s why it’s particularly delicious to read Who’s Afraid of Gwyneth Paltrow and Goop? by Elisa Albert and Jennifer Block, two privileged white women who defend the sacred right of another privileged white woman to defraud consumers. They imagine themselves as feminists when they are nothing more than fools, fronting for a marketing machine.

GOOP is a corporation devoted to profit and it profits by promoting conspicuous consumption of luxury products to wealthy women. Why is it being criticized by mainstream physicians and scientists? Because it makes false, unscientific and often fabricated claims about those products.

Because it’s really about money.

Albert and Block are astoundingly credulous. To read their piece you wouldn’t know that GOOP exists to sell products and is being criticized because their products not only don’t work as advertised, but literally can’t work as advertised.

Block and Albert plaintively ask:

So what underlies all the overwhelming, predictable, repetitive critiques? What exactly is so awful about a bunch of consenting adults seeking self-knowledge, vitality and emotional freedom?

They mobilize the tired tropes of radical feminism to defend a bastion of capitalism, a traditionally patriarchal economic system.

Throughout history, women in particular have been mocked, reviled, and murdered for maintaining knowledge and practices that frightened, confused and confounded “the authorities.” (Namely the church, and later, medicine.) Criticism of Goop is founded, at least in part, upon deeply ingrained reserves of fear, loathing, and ignorance about things we cannot see, touch, authenticate, prove, own or quantify.

No, throughout history women have been mocked, reviled and murdered for daring to expect the same rights and privileges as men. It had nothing to do with their “knowledge” and everything to do with the naked abuse of power that is misogyny.

Block and Albert mobilize the tropes of religion to undercut science, promoting the same arguments used by flat-earthers and creationists that belief is equal to science.

Our society likes to conjoin the concepts of science and health, but the two do not always overlap. Peer-reviewed, lab-generated, randomized, controlled, double-blinded evidence will always be the gold standard, but such studies aren’t always fundable, or ethical.

They mobilize New Age nonsense to promote traditional profiteering:

But it’s condescending to suggest that if we are interested in having agency over our bodies, if we are open to experiencing heightened states of awareness and emotion, if we are amazed by and eager to learn more about the possibilities of touch and intention and energy, and if we’d like to do everything within our power to stay out of doctors’ offices, we are somehow privileged morons who deserve an intellectual (read: patriarchal) beat-down…

But buying luxury products from GOOP is not asserting agency over your body; it’s allowing Gwyneth Paltrow agency over your wallet.

Because it’s really about money.

But I suspect that Albert and Block know that; they sell pseudoscience through their writing and for them, as for Paltrow, it all about the money.

The US maternal mortality rate has become a scandal. Too many women, particularly women of color, die of pregnancy related causes or in the year after giving birth.

But a comparable scandal, in my view, is how we let maternal mortality rise so high. We deliberately ignored the actual data about maternal mortality in favor of a conventional wisdom that blamed C-sections rates, obstetric technology and obstetricians.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]We ignored the actual data about maternal mortality in favor of a conventional wisdom that blamed C-sections rates, obstetric technology and obstetricians.[/perfectpullquote]

A new report from the CDC, Evaluation of the Pregnancy Status Checkbox on the Identification of Maternal Deaths, confirms the scandalous truth.

An article from CBS explains the findings:

Maternal mortality is much higher among black women.

The maternal death rate among black women was 37.1 deaths per 100,000 live births, a rate up to three times the rates for non-Hispanic white and Hispanic women, the report said.

Maternal mortality is not, by and large, a problem of death in childbirth; it’s a problem of women dying AFTER being discharged from the hospital.

Maternal mortality is not a problem of pregnancy complications; it’s a problem of pre-existing chronic conditions exacerbated by pregnancy.

Heart disease and stroke caused more than 1 in 3 pregnancy-related deaths between 2011 and 2015 in the United States, according to the CDC.

Maternal mortality reflects the increasing age of pregnant women.

The data also showed the maternal death rate among women 40 and older was 81.9 deaths per 100,000 live births, almost eight times the number for women under 25.

Maternal mortality has NOT been rising precipitously as has been claimed repeatedly. The new report has finally eliminated the errors due to disparate methods of reporting in different states. The maternal mortality rate in 2018 is almost exactly the same as it was in 2007.

The US maternal mortality rate did NOT double from 1991 to 2015 as activists repeatedly claimed. Nearly all of the purported increase was due to better reporting, not increased deaths.

From the actual report:

Without the adoption of the checkbox item, maternal mortality rates in both 2015 and 2016 would have been reported as 8.7 deaths per 100,000 live births compared with 8.9 in 2002. With the checkbox, the maternal mortality rate would be reported as 20.9 and 21.8 deaths per 100,000 live births in 2015 and 2016.

I feel justified in saying ‘I told you so.’

Nearly 10 years ago I made many of these points in an article for Salon Magazine, Is there really a “maternal mortality crisis?”.

…[I]t is not clear that maternal mortality is even rising, let alone rising because of decreased access to care or increases in the C-section rate. Review of the data suggests that changes in the way that maternal mortality is assessed may be leading to a spurious “increase” in maternal mortality. Moreover, a detailed analysis of the causes of maternal mortality casts serious doubt on either access or interventions as the reason for any rise.

Over the years I’ve continued to question the conventional wisdom:

The rise in US maternal mortality: the cause will surprise you
Is US maternal mortality rising? Maybe not.
Latest data on US maternal mortality confirms it is a problem of race and healthcare disparities
Experts acknowledge MORE interventions are needed to reduce maternal mortality
Surprise! CDC confirms US maternal mortality rate is high because pregnancy is inherently dangerous.

In 2017, in the wake of a blockbuster report from ProPublica and NPR that advanced the conventional wisdom, I noted:

The take home message about maternal mortality in the US is a lot more nuanced than the ProPublica/NPR piece implied. It’s not a problem of privileged white women who are victims of malpractice. It is a problem with profound racial disparities and changing causes of death. And it’s also a story about what happens when people forget that pregnancy is inherently dangerous and demonize technology instead of using it to save lives.

The problem of maternal mortality persists because we refuse to recognize the nature of the problem and refuse to take the steps necessary to reduce it:

We must stop demonizing C-sections and interventions; they are lifesaving and it is the LACK of interventions that kills pregnant and postpartum women.

We must acknowledge the critical role of race/ethnicity including the fact that international comparisons of maternal mortality are invalid if they don’t correct for race/ethnicity.

We must stop pretending that more midwives and doulas (promoted because they are less expensive) can reduce maternal mortality. The problem is lack of perinatologists and obstetric intensive care units and midwives and doulas cannot fix that.

We must stop pretending that pregnancy is inherently safe when it is inherently dangerous and becomes more dangerous still when women are older or have pre-existing chronic conditions. We should never “trust” birth but should drill endlessly on quick response to hemorrhage, pre-eclampsia and other deadly complications.

In my view, the most important fact about US maternal mortality is this:

…[A]lthough Washington, DC, has the highest maternal mortality ratio in the nation, non-Hispanic white patients in this district have the lowest mortality ratio in the United States…

We are capable of providing excellent, life saving care for those who can afford it. If we want to reduce maternal mortality, we must ensure that all pregnant women — regardless of ability to pay — have access to the highest quality obstetric care.

Another day, another scandal in UK midwifery care. This time it’s not dead babies and dead mothers, all though there are far too many of those. This time it’s the sadistic behavior of midwives.

According to The Telegraph:

Women in labour are being denied epidurals by NHS hospitals, amid concern that a “cult of natural childbirth” is leaving rising numbers in agony.

Mothers said they were told “It’s not called labour for nothing, it’s meant to be hard work” as doctors refused their pleas.

The problem is so widespread that the rate of epidural use is dropping overall:

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Midwifery violence: bullying, pain shaming and denial of epidurals and maternal request C-sections.[/perfectpullquote]

Official guidelines … state that women must be able to access pain relief when they request it, including epidurals.

However, this newspaper has identified six NHS trusts where women pleading for pain relief were refused it.

It comes as official figures show the number of women given pain relief during child birth has fallen. The statistics from NHS Digital show the percentage of women in labour given pain medication such as epidurals has fallen from 67 per cent in 2008-09 to 61 per cent in 2018-19.

Rhiannon Evans of Grazia refers to this practice as pain-shaming:

…[U]nlike the arenas of mental health, other pain, or addiction, where it feels like things are starting to change and messages of kindness are starting to filter through to our collective consciousness, birth is a bizarre no-mans-land of medicine and shame.

It’s a place where the old and new collide, but women are still left worse off. It’s a strange area where the old world says, ‘Come on, this is how we’ve done it for centuries, stiff upper lips, please, women!’ and the new world says, ‘No, it’s your body, your choice, you can do this, women are amazing, but did you know breathing is the greatest anaesthetic ever and breast milk is the cure for everything you could ever imagine?!’ The place where those two worlds intersect is the place where women deal with birth and pregnancy every day. And for many of us, it’s a grim place to be. It’s where the so-called ‘cult of natural childbirth’ lives.

Maybe there would be more attention devoted to midwives’ unethical behavior if we gave it a name. I suggest “Midwifery Violence.”

What’s the definition of midwifery violence?

It is an umbrella term that includes coercion, bullying, pain shaming and denial of epidurals and maternal request C-sections.

Forcing women to labor in pain when effective pain relief is available is sadistic.

In Eve’s punishment rebooted: The ideology of natural birth, philosopher C.K. Egbert explains:

There’s something pornographic about the way we depict childbirth. A woman’s agony becomes either the brunt of a joke, or else it is discussed as an awesome spiritual experience… [W]e talk about the pain of childbirth — with few exceptions, the most excruciating, exhausting, and dangerous ordeal within human experience — as valuable in and of itself. Hurting women is sexy.

Midwives justify their sadism as “better” for babies and mothers. Egbert makes it clear that this justification is nonsense:

… We probably wouldn’t give much credit to an argument that we should strap patients to the operating table and refuse them anesthetic during surgery, even though general anesthetic is usually the most dangerous part of surgery. Rather than eliminating palliative care, we seek safer and more effective means of performing surgeries and administering anesthetic.

Natural birth advocates are not concerned with women’s welfare, because they are not advocating for safer and more effective forms of pain management; they argue they should be eliminated, because women’s suffering is itself a good…

None of this is surprising when you consider that the philosophy of natural childbirth was created by old, white men (Grantly Dick-Read, Lamaze, Bradley) and perpetuated by old, white men (Odent, Marsden Wagner) who tried to convince women that the pain of childbirth was in their heads, not their bodies. And the philosophy of natural childbirth has been perpetuated by white women (midwives, doulas and childbirth educators) who enjoy wielding power over other women and glory in humiliating them for failing to mirror their own choices back to them.

The midwives and doulas who chivvy women into refusing pain relief, who “delay” calling the anesthesiologist when a woman requests an epidural, who promote inadequate forms of pain relief (waterbirth) and praise women as warrior mamas (i.e. “good girls”) for enduring labor without pain relief are sadists. They believe that women’s pain and suffering aren’t worthy of their compassion and concern. They believe that women are improved by agonizing pain, and diminished by relief.

And that is midwifery violence.

Yesterday I expounded upon The extraordinary conceit of anti-vaxxers on my Facebook page:

When it comes to the benefits of vaccination, there is rare unanimity across scientific disciplines and across national borders. Nearly every immunologist in every country promotes vaccination as life saving and safe; nearly every pediatrician in every country recommends vaccination as the best, most effective form of preventive care in existence; nearly every epidemiologist in every government and health organization views vaccination as one of the greatest public health victories of all time.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]No amount of attempted intimidation changes the fact that vaccines are safe and effective.[/perfectpullquote]

How conceited do you have to be to imagine that you, a lay antivaxxer, know better?

Very, very, very conceited.

It didn’t take long for the anti-vaxxers to appear at the behest of Stop Mandatory Vaccination.

Guys, Time to go and give your opinion to this OB nonsense.

At the moment, there have been more than 2,300 comments on the post, most from anti-vaxxers.

Where did they get the idea I care what they think?

I don’t.

Anti-vaxxers, science is not a democracy. The belief with the most votes does not win. And no amount of attempted intimidation changes the fact that vaccines are safe, effective, and don’t cause non-specific “injuries.”

The Catholic Church tried intimidation on Galileo and it didn’t change the fact that the sun, not the earth, is at the center of the solar system.

A variety of the world’s religions tried intimidation on Charles Darwin and it didn’t change the fact that humans evolved and were not created de novo.

Semmelweis’ colleagues tried intimidation on him and it didn’t change the fact that doctors refusing to wash their hands spread disease.

Don’t get me wrong; I’m NOT saying that anti-vaxxers’ personal experience is irrelevant in medicine. In the aggregate, your experience is an important aspect of scientific evidence.

But anti-vaxxers personal BELIEFS are irrelevant! It doesn’t matter whether you think we evolved; we did. It doesn’t matter whether you think hand washing prevents disease; it does. And it doesn’t matter whether you think that vaccines aren’t safe and effective; they are.

I don’t doubt your sincerity. In the 16th Century ignorant, gullible people blamed demons for diseases they did not understand. They were extremely sincere in that belief. In the 21st Century you blame vaccines. You are equally sincere, but you are also equally wrong.

I’m not going to stop you from coming to my Facebook page to share your experiences and your “knowledge” (such as it is). If you want to preen before your equally ignorant anti-vax colleagues, have at it! But don’t be confused: I will never take you seriously when you don’t know a damn thing about science, medicine or statistics.

Get an education and then get back to me.

In the meantime your attempted intimidation won’t change the scientific evidence that vaccines are safe, effective and one of the greatest public health achievements of all time.

A new paper in The Journal of Maternal-Fetal and Neonatal Medicine, Predictability of prognosis of infantile hypernatremic dehydration: a prospective cohort study sheds light on the outcome of newborn dehydration due to insufficient breastmilk. It highlights the severity of the problem, the risk factors and the prognostic signs.

I find it particularly interesting because it describes almost exactly the clinical course of babies like Landon Johnson, who died of breastfeeding dehydration, and the son of Dr. Christie del Castillo-Hegyi, who suffered permanent brain injury. Lactation professionals have insinuated or even denied that those babies suffered and died as a result of insufficient breastmilk. This paper makes it clear that it is the lactation professionals who are woefully (and often willfully) ignorant of what is going on around them.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]17.5% of babies suffered permanent brain injury including 7% who died.[/perfectpullquote]

The authors start by acknowledging what lactation professionals refuse to admit — the risk of newborn hypernatremic dehydration is increasing:

The prevalence of hypernatremic dehydration has increased in recent years most likely due to insufficient intake of breast milk as the most important factor. Other influencing factors include: early discharge of mothers from hospital after delivery, inadequate training, awareness on breast milk insufficiency and improper breastfeeding technique, breast congestion, inverted, big or flat nipple, previous breast surgery …

As breastfeeding promotion efforts have become more aggressive, more babies are suffering the serious impact of insufficient breastmilk.

In contrast to the claims of lactation professionals, breastfeeding dehydration is NOT easy to diagnose:

Infantile hypernatremic dehydration (IHD) is a life-threatening medical emergency in which the intracellular water is sucked into the extracellular space due to sodium chloride hypertonicity usually induced by free water loss or administration of excessive sodium solutions. As a result, the intracellular volume is extremely decreased while the intravascular volume and skin turgor are maintained, resulting in difficulty in early diagnosis…

Why are babies so vulnerable to dehydration?

Following low milk intake in neonates, kidneys start sodium reabsorption and fluid retention; however, kidneys in neonates have a weaker ability of urine concentration compared to adults and hence water is not reabsorbed sufficiently. Besides, insensible fluid loss through the lungs as well as immaturity of neonatal skin can amplify dehydration and hypernatremia. Due to the gradual development of the disorder, the diagnosis is very difficult and dehydration is usually undetected. Accordingly, most infants are referred to the physician when neonatal complications such as decreased urination, lethargy, weakness or brain symptoms have already been presented.

Hypernatremic means high salt concentration and it is the high salt concentration that leads to brain injuries.

Long-term follow-up has shown that neurological disorders occur in approximately one-third of infants with hypernatremic dehydration. Also, developmental delay has been shown to occurs in cases with severe hypernatremia. Monitoring birth weight, breastfeeding position and frequency, and breast changes during breastfeeding as well as defecation and urination frequency are effective measures in early diagnosis of hypernatremic dehydration and controlling its complications.

In an effort to determine prognosis, the authors looked at the impact of dehydration on 183 babies. The results are frightening:

The 36-month follow-up of infants with hypernatremic dehydration showed that 32 (17.5%) out of 183 studied cases had abnormal outcomes, out of whom 14 cases have passed away during the follow-up and 18 cases were diagnosed with developmental delay.

Remarkably, these results were BETTER than results from previous studies:

The lower incidence of developmental delay in our study can be attributed to the larger sample size, the longer duration of follow-up, and/or the difference in measurement tool for the developmental status in our study.

There were notable difference between the babies who suffered serious long term effects and those who did not:

Hypernatremic dehydrated infants with unfavorable prognosis had been referred 4 days later than those with favorable prognosis…

According to the results of this study, hypernatremic dehydrated infants with developmental delay had serum sodium levels significantly higher (176 mEq/l) than those with the normal outcome (157 mEq/l). Also of 32 hypernatremic dehydrated infants with abnormal outcomes, 26 cases (81%) had a sodium level of 167–200 mEq/l.

In addition:

Convulsion was seen almost 5 times more (34%) in infants with unfavorable prognosis compared to those with normal prognosis (7%)… Consciousness impairments were observed in 32% of infants with unfavorable prognosis, but none were observed in those with normal prognosis. Cerebral edema was observed in about one-third of infants with unfavorable prognosis… Cerebral edema can be irreversible and hence fatal in some patients.

The authors conclude:

According to the results of this study, hypernatremic dehydration is a major problem with a common occurrence in the first 2 weeks of life that leads to unfavorable outcomes such as infant mortality (7%)… [C]ombination of variables such as sodium, urea, creatinine, lethargy, state of fontanels, convulsion, loss of consciousness, state of breast during postpartum, inverted nipple and brain CT scan had a high predictive power (98.6%) for determination of unfavorable prognosis in infants with hypernatremic dehydration.

Breastfeeding dehydration leads to grievous outcomes … and the ultimate tragedy is that nearly every single one of these tragic outcomes can be avoided simply and easily by supplementing with formula at the first sign of problems.

Breastfeeding ISN’T best for every baby. For some it is brain damaging and life ending.

A new paper succinctly lays out the academic critique of contemporary breastfeeding promotion, and basically recapitulates most of the arguments I have been making for years.

The paper is Discourses and critiques of breastfeeding and their implications for midwives and health professionals by midwives Smyth and Hyde.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Current policies must change to reflect the truth — not the wishful thinking — about breastfeeding.[/perfectpullquote]

While the slogan ‘breast is best’ has historically been a truism in health promotion discourses internationally, in recent decades, criticisms have emerged that challenge the campaign for breastfeeding. In this article, we consider a number of strands in the debate, starting with discourses of breastmilk and breastfeeding used to promote breastfeeding and then move on to explore charges that the em- pirical support for breastfeeding is not as strong as breastfeeding advocates often suggest.

1. The benefits of breastfeeding have been overstated.

While official organisations collectively promote breastfeeding on the grounds of scientific evidence, the science behind the consensus of breastfeeding has been challenged. Wolf asserted that many research studies linking breastfeeding to improved health are weakly significant and often fail to control confounding variables that could affect the outcomes…

Indeed, the benefits predicted by breastfeeding researchers — that increased breastfeeding rates would lead to decreased infant mortality, severe morbidity and healthcare expenditures — have failed to materialize.

2. Bias in promoting breastfeeding

Parallel to the increase in research on the health outcomes of breastfeeding in biomedical literature, including less than strong evidence of its superiority, social science literature (predominantly) has criticised the pro-breastfeeding discourse as problematic and biased. A growing concern is that educational and promotional breastfeeding literature has become one-sided and more a tool for persuasion than education and replete with hyperbole (Wolf, 2011). Knaak raises the question ‘Are we educating or advertising?’ Foss noted how the media have been criticised for perpetuating the ‘myth’ of breastfeeding as a choice. Indeed, breastmilk has been so highly regarded in media discourse that it has been suggested that the result is an implied assumption that ‘breastfeeding is the only ethically acceptable option in infant feeding’.

3. Ignoring the harmful impact on many women

For the woman who experiences great difficulties in breastfeeding and for whom breastfeeding is a less than joyous experience, feelings of guilt and failure may provoke a crisis in her sense of self. Williamson [et al.] noted that women were often surprised by the difficulties faced when breastfeeding and experience anxiety, upset and damage to their self-worth when breastfeeding fails. Foss … [noted] that [“breast is best”] is ‘dripping with insinuation on a mother’s inferiority and attributions of blame for not breastfeeding’. In Símonardóttir and Gíslason’s study, women experienced difficulties and pain (often severe) when breastfeeding with negative consequences for their emotional well-being. The pressure to breastfeed was linked to postnatal depression by several women in the study and one described her experience of feeling constantly guilty and ‘like a terrible failure’ for ‘not being able to perform this simple task’.

4. Ignoring the impact on women’s economic and professional status

Law argues that breastfeeding serves to consolidate the maternal role in the home, exacerbates the gendered division of labour and negatively impacts on women’s participation in the workforce. This limits women’s choices and impedes their progress in paid employment, sustaining their economic dependency on men. Law (correctly) asserts that promotional material about breastfeeding fails to mention the negative outcomes of breastfeeding, including its impact on women’s economic position in society in the long run. While breastfeeding may be free at the point of delivery … the cost to women’s lifetime earnings because of their lost years in the workforce does not get toted up, and thus, they trail behind men in terms of power and privilege.

So the benefits of breastfeeding have been exaggerated, breastfeeding promotion is biased, and the harmful impact of breastfeeding on women’s mental health and economic status has been entirely ignored.

How are midwives supposed to counsel women when the Baby Friendly Hospital Initiative makes claims aren’t supported by the scientific evidence?

The fact that midwives and other health professionals may work in hospitals that are signatories to the Baby Friendly Hospital Initiative potentially places them in a difficult position, where their own critical assessment of the practice of breastfeeding may be silenced by the need to convey an official pro-breastfeeding position.

Current policies must change to reflect the truth — not the wishful thinking — about breastfeeding. It’s the mother’s baby, the mother’s body, and it ought to be the mother’s choice how to feed her infant, free from manipulation by healthcare professionals.