You’ve probably heard of first world problems.

As the website First World Problems explains, “It isn’t easy being a privileged citizen of a developed nation.”

Consider:

The sun is too bright for me to read my iPhone screen.

Or:

I tried to unlock the wrong Prius today. Twice.

And my personal favorite:

I can’t find the remote.

There’s a corollary that you probably haven’t heard about: first world achievements.

That’s when a privileged denizen of the first world brags about dealing with her first world problems. For example:

I’m so proud of myself for reading my iPhone screen even thought it was sunny.

Or:

Even thought there were lots of Prius’ in the Whole Foods Parking Lot, I immediately unlocked my own Prius.

Or:

I was able to find my TV remote without help.

Or, my personal favorite:

I am so proud of myself for having an unmedicated childbirth.

As you can see, first world “achievements” aren’t achievements at all. They are what passes for an achievement among privileged women who don’t have real achievements and have to make some up to feel good about themselves. They are all variations on the same theme: Look at me! Here’s how I dealt with the “problem” of the luxuries in my life.

Unmedicated childbirth is the paradigmatic first world achievement. Any woman could do it. Most women who have ever lived have already done it, and most women who give birth around the world do it each and every minute of each and every day 24/7/365.

Do natural childbirth advocates consider unmedicated childbirth an achievement for an Afghan teenager? No. How about for a woman who accidentally gives birth on the side of the road because she didn’t make it to the hospital in time? Nope, not an achievement for her. How about our grandmothers, great grandmothers and other female ancestors who gave birth without pain medication? No, it wasn’t an achievement for them, either.

Clearly, it isn’t experiencing the pain that is the “achievement”? So what are these woman boasting about? They are boasting that they had access to effective pain relief but they refused it.

And not just any pain: It’s not an achievement to refuse Novocaine for a root canal, and it’s not an achievement to refuse general anesthesia for an appendectomy. That’s considered foolishness.

And not just any pain relief: It’s perfectly acceptable, indeed entirely compatible with natural childbirth, to reduce the pain of childbirth by lying in a kiddie pool filled with fecally contaminated water.

So if it’s not the ability to tolerate pain (since women who have unmedicated childbirth because they have no other choice haven’t achieved anything), and it’s not simply enduring pain (since NCB advocates wouldn’t consider unmedicated migraines or kidney stones to be an achievement) and it’s not the refusal of pain relief per se (since no NCB advocate thinks it is an achievement to refuse anesthesia for surgery), what is it?

It’s their own special, carefully defined, easy to accomplish “achievement”:

I was presented with a luxury option and chose to forgo it.

We’re supposed to be impressed by that?

Frankly, I’d consider it more of an achievement if you learned to program the remote.

In my efforts to expose American homebirth midwives as woefully ignorant fools I have no better allies than homebirth midwives and their supporters.

Case in point, this tweet from the annual conference of the Midwives Alliance of North America (MANA) that took place this weekend:

The woman behind this statement is Roanna Rosewood. According to her website:

Roanna is an the author of the Amazon Bestseller, Cut, Stapled, & Mended: When One Woman Reclaimed Her Body and Gave Birth on Her Own Terms After Cesarean, an award-winning international speaker, co-founder and host of Birth Plan Radio, and the executive action chair of Human Rights in Childbirth and most importantly, a mother. In her not-so-humble opinion, the latter makes her a true birth expert.

Bestseller? It’s #143,785, but Roanna is obviously into hyperbole.

Human Rights in Childbirth? You remember them, the folks who think human rights in childbirth means protecting baby slaughterers and other incompetents.

Being a mother makes her an expert in birth? I wonder if she thinks she’s an expert in cardiology because she has a beating heart.

There are only a few words in the tweet, but they convey so much about American homebirth midwives:

1. They are startlingly immature

Rosewood’s claim is a great example of the magical thinking that characterizes American homebirth midwifery. If you wish it, it is so. You can be a best selling author even when your book is ranked #143,785 because you said so. Defending women who commit manslaughter constitutes supporting human rights in childbirth because you said so. You’re an expert in birth because you said so. Your vagina has “superpowers” because you said so.

2. They lack basic education in childbirth

This is obviously going to come as a shock to the folks at MANA, but the vagina has no powers at all in childbirth. In is entirely passive. The uterus and the mother’s pushing efforts do all the work. Claiming that the vagina is powerful in childbirth is like claiming that the highway makes cars function.

3. They are biological essentialists

Women are constantly being reduced to their uteri, vagina and breasts. I’ve yet to see a homebirth advocate claim that her brain has superpowers. Why is that?

4. They are woefully lacking in self-esteem

You really have to have a pathetically low sense of self-esteem to be impressed with the notion that your vagina has superpowers.

5. They are fools

Not only did a nitwit make a ridiculous statement, but it was promptly and publicly relayed to the other fools following MANA13 as if it were wisdom.

Homebirth kills babies and it’s easy to see why. Anyone who believes that women’s vaginas have superpowers is not qualified to provide care in the inherently dangerous process of childbirth.

Why would any woman hire fools like these?

I’m currently reading a widely praised book on raising children who are very different from their parents. The book is Far From the Tree: Parents, Children and the Search for Identity by Andrew Solomon. It’s about one of the most challenging aspects of parenting, recognizing that your child is not you and that’s okay. The task is made far more difficult when the child differs from you in major ways: children who are deaf, autistic, transgender, etc.

One aspect common to parenting children with major differences is self-blame, at least in the early stages.

Solomon writes:

…The attribution of responsibility to parents is often a function of ignorance, but it also reflects our anxious belief that we control our own destinies. Unfortunately, it does not save anyone’s children; it only destroys some people’s parents, who either crumble under the strain of undue censure or rush to blame themselves before anyone else has time to accuse them… Many parents … organize their guilt around some fictitious misstep. I had lunch one afternoon with a highly educated activist whose son suffers from severe autism. “It’s because I went skiing while I was pregnant,” she said to me. “The altitude isn’t good for the developing child.” I felt so sad hearing this. The roots of autism are confusing, and there are questions as to what may dispose children toward the condition, but altitude is not on the list. This intelligent woman had so assimilated a narrative of self-blame that she didn’t know that it had come out of her imagination.

It is quite startlingly how desperately parents, particularly mothers, try to blame themselves for their child’s autism. How I Gave My Son Autism is a horrifying example of this narrative of maternal self blame.

I am admitting here for all the world to see: I gave my son Autism. I did it. Me. And no one can ever take that away.

So . . . how did I give my son autism? I wish I could say it was one thing – one thing that I could take back that would make things neat and easy, but it wasn’t. It was mistake after mistake, assault after assault. The following are the biggest mistakes I made to which I attribute my son’s descent into autism…

The list of the mother’s supposed transgressions is mind boggling:

• Ultrasound
• High fructose corn syrup
• Tylenol
• Pitocin
• C-section
• Antibiotics
• Vaccines
• Flouride

For example:

I had at least five while I was pregnant. I was assured that they were completely safe. Heck, you can get them in malls, so I assumed they were pretty benign. Wrong! While I didn’t get ultrasounds in malls, I didn’t research them either. Ultrasounds have, in fact, been implicated in autism among other neurological disorders…

No it hasn’t. There is no scientific evidence for ANY of the supposed transgressions on this list as a cause of autism, but then there is no evidence that altitude is a cause of autism, either, yet that didn’t stop the mother in Solomon’s example from invoking it.

The mother declares:

I am already anticipating three different responses to this post:

Response 1) There will be people who read this and think, “Good grief, woman. How stupid can you be? What you did borders on child abuse. OF COURSE your child has Autism.” And to that, I have no argument. You are absolutely right. And good for you for knowing better than I did.

Response 2) Some of you will read this and know exactly how I feel because your story is very similar. To all of you, you have my deepest, heartfelt sympathy. While we will always have our mistakes to live with, the best thing we can do now is to share our truth and our story to help others.

Response 3) There will be people who feel pity for me because I have not been able to make peace with myself for my role in my son’s health crisis. You will feel compelled to reach out to me with kind messages imploring me to forgive myself. Please . . . don’t. It won’t do any good. I am not fishing for forgiveness, and while I know you mean well, it won’t help me… No child should have to endure what mine has endured. No mother should ever have to experience the kind of torturous guilt I live with every day.

This is the flip side of magical thinking so integral to natural childbirth, attachment parenting and vaccine rejection. If what you think and do has the power to keep your child safe, it follows that if your child has an affliction, it must be your fault. Indeed it is easier for mothers to blame themselves than to acknowledge the frightening reality; autism is basically random, due to genetics and can’t be prevented.

Apparently it is better to be powerful and wrong than to be utterly powerless in controlling our children’s destinies.

Kudos to the more than 400 people who have signed the online petition demanding that the Midwives Alliance of North America (MANA) release the death rates for the 27,000+ homebirths in their database. It has been swiftly and remarkably successful.

I created the petition on October 1.

On October 4 MANA began censoring comments on their blog after refusing to reveal the death rates.

Also on October 4th, after learning that both Melissa Cheyney CPM and Wendy Gordon CPM (and placenta encapsulation specialist!) were feeling pressured by my “attacks,” I offered this challenge:

Stop lying! Stop hiding! Stop trying to bury dead babies twice, once in the ground and the second time in our collective memories.

How dare you two lie to American women by omission or commission? I never had any doubt that you aren’t healthcare providers; I’ve always known you are lay people trying to get paid while you get your birth junkie fix, but really??!! Have you no decency at all?

Release the MANA death rates. Stop lying about existing research. Start acting like the healthcare providers you claim to be and not a bunch of selfish, self-absorbed women who casually step over the tiny bodies of babies who didn’t have to die on your way to picking up a check.

On October 24, ahead of the MANA13 national conference taking place this weekend, Cheyney felt compelled to spew more BS in an effort to justify the fact that MANA has been hiding their death rates for nearly 5 years.

They say that when you can’t dazzle them with brilliance you can always baffle them with bullshit and apparently that’s Cheyney’s motto, too. Cheyney employs a lot of words to tell us nothing. Well, not exactly nothing. She can’t resist yet another whopper.

Cheyney claims that the MANA statistics cannot be released without the approval of an IRB (institutional review board).

The code of federal regulations # 21 part 56 requires it, and researchers cannot submit findings for publication unless they have gone through appropriate procedures to access data. You must have IRB clearance before you analyze data for publication.

First, MANA itself has published almost all the data from the database EXCEPT the death rates.

Second, while IRB approval could be required for publications based on the data, IRB approval is not required to read and review the data.

Finally, Federal regulations #21 part 56 concerns studies leading to FDA approval of drugs or devices and has nothing to do with the MANA data.

Cheyney also has this revelation for us:

I’m excited to report that a group of researchers and I have two papers on the MANA Stats 2.0 dataset coming out in the Jan/Feb 2014 issue of the Journal of Midwifery and Women’s Health…

M: This article looks at the demographics of the MANA Stats data set 2004-2009, including the intended place of birth and the type of midwife in attendance …

It also looks at standard maternal-child health outcomes and home birth indicators, like transfer rates, i.e. intrapartum transfer, neonatal transfer, maternal postpartum transfer, and it looks at reasons for those transfers. It also examines cesarean section rates and spontaneous vaginal birth rates. It also examines intrapartum, early neonatal, and late neonatal mortality. Finally, it explores rates and type of tearing, hemorrhage, and NICU admissions.

That’s funny. As recently as September 29, Wendy Gordon claimed that there were no articles in press, and now there are suddenly two that will be published in less than two months?

So nearly 5 years after the data was analyzed, MANA has decided to publish it. Johnson and Daviss took 5 years to figure out how to spin the CPM death rate in the 2005 BMJ homebirth study. They finally decided to compare homebirth in 2000 to hospital birth in a bunch of out of date papers extending back to 1969. That’s how they concealed the fact that homebirth had a death rate nearly triple that of low risk hospital birth in the same year.

I expect a similar attempts from Cheyney at burying the deaths of homebirth babies. She should report how many homebirth babies died compared to how many homebirths were intended. What might she do instead?

Here are just a few possibilities:

Compare homebirth to high risk hospital birth including premature babies

Exclude breech, twins, VBAC and postdates from the homebirth deaths as “high risk” even though Cheyney has spent years trying to convince the state of Oregon that they’re not

Follow the lead of Colorado homebirth midwives are report the result in an incomprehensible way like deaths per midwife

Take a page from Oregon homebirth midwives and obfuscate the data by adding in all prenatal stillbirths thereby dramatically diminishing the impact of homebirth deaths.

I’m sure that Cheyney will do something to hide the hideous death rate at CPM attended homebirth. I’m so sure, in fact, that if I’m wrong, I will publicly apologize to Cheyney and donate $100 to the MANA stats project.

It’s a win-win for me. If I’m wrong, and Cheyney publishes the number of homebirth deaths compared to the total number of attempted homebirths, I’ll finally have access to the data. If I’m right, I’ll save $100 and I’ll be able to say that you heard it here first that MANA would try to hide the many homebirth deaths at the hands of their members.

No matter what, though, we’ve already shown the power of a public petition. In less than one month, MANA has already been forced to release data to counteract the charge that they’ve been hiding their death rates for nearly 5 years. It’s a small, but real victory.

If you haven’t signed the online petition yet, please do so. We can’t let up the pressure on MANA to release the data that will allow women to make an informed decision about homebirth.

I’ve been writing about this issue for years, but it has finally made it in to the mainstream. In a piece on Time.com, Bonnie Rochman asks Is “Birth Rape” for Real? The answer is a resounding NO!

What is “birth rape” supposed to mean? It doesn’t mean rape during birth, although that is indeed possible, and no doubt has actually occurred.

As Rochman tells us:

In a post on Salon.com by Tracy Clark-Flory, Reed explains the phenomenon: “Fingers, hands, suction cups, forceps, needles and scissors … these are the tools of birth rape and they are wielded with as much force and as little consent as if a stranger grabbed a passer-by off the street and tied her up before having his way with her.”

According to Amity Reed, the Al Sharpton of birth activists, birth rape is:

an instance during labor “when an instrument or hand is inserted into a woman’s vagina without permission, after which the woman feels violated.

Like Sharpton who cries “racism” regardless of the circumstances, Reed cries rape regardless of the circumstances. But the circumstances matter.

We have a word for medical care without permission and the word is “assault.” But childbirth activists abuse the word “rape,” and demean the experience of victims of actual rape, because they are desperate for attention. The promiscuous use of language, as when people abuse the term “lynching” or “racism” any other shocking term, is a sure-fire attention getter.

They’ve figured out that “I didn’t like the way the obstetrician treated me when he was trying to save my baby’s life” is not particularly compelling, since anyone who has ever suffered a serious medical problem knows that doctors give priority to saving lives in life threatening situations, rather than respecting emotional sensitivities. Let me be very clear about this point: I’m NOT saying that doctors are always right. Often more compassion could be shown without compromising life saving efforts in the least. But lack of compassion is not rape, either.

What is the actual definition of rape?

the unlawful compelling of a woman through physical force or duress to have sexual intercourse.

The legal definition has been expanded to include other forms of sexual touching that do not involve intercourse. And while it is true that we have come to understand that rape is often more about power than sex, we limit the meaning of rape to sexual contact. We have a different word for non-sexual harm; that word is assault. This is a critical point. We don’t discount any form of abuse or harm, but we do insist on precision in describing and punishing it.

And we do not determine whether a crime has occurred by referencing the feelings of the victim. The feelings of the victim matter not at all; what matters are the “feelings” of the perpetrator. We a name for the perpetrator’s feelings: intent.

All crimes require more than a physical act. They require intent, legally known as mens rea or the guilty mind. Consider the crime of murder. A person run down by a driver who was texting is every bit as dead as a person run down by a professional hit man intending to cause the death. But only the latter case is murder, while the former is manslaughter at most. Intent is absolutely critical to determining whether a crime has been committed and what type of crime has been committed.

It does not matter how the victim feels about the crime (or in the case of murder, how the victim theoretically would feel about the crime). It does not matter that the relatives of the victim run down by a texting driver “feel like” the victim has been murdered, and that’s not because we discount their feelings. We are actually quite sympathetic to the anger and sense of loss of the victim’s relatives.

Let’s look again at “birth rape.” Rape requires sexual touching. A man can punch a woman and it is not rape. It might be assault, but it is not rape. Why? Because it is not sexual touching.

And it’s not merely a matter of the identity of the body part that has been touched. A woman can kick a man in the crotch, but that is not rape either. It might be assault, but it is not rape. Why? Because intent matters.

The victim’s feelings about the matter are irrelevant. The woman who was punched can “feel” like she was being raped, but that doesn’t make it so. A man who was kicked in the crotch might “feel” like he was being raped, but that doesn’t make it so.

And, as I mentioned above, a woman in labor can actually be raped. Do childbirth activists actually expect us to believe that a vaginal exam without consent is the equivalent of forced sexual intercourse during labor? I can’t imagine they do. And if they can tell the difference between the two scenarios, then they are aware that they are misusing the term rape.

“Birth rape” does not exist. It is a promiscuous abuse of the term rape for the sole purpose of garnering attention. The term is legally meaningless and ethically suspect. It is morally wrong to insist that a rape has occurred when nothing of the kind happened. It is ethically unjustified to misuse the term rape regardless of how worthy the motivation. And it is insupportable to base the accusation of a crime on how the victim “feels” about it.

In case you thought yesterday’s discussion of maternal autonomy vs. “the best interests of the child” was just an arcane academic discussion, today comes word of a pregnant woman forced into a drug treatment program (even though she was not taking drugs) because her doctor thought it would be in the best interests of the child.

The New York Times reports reports on the case of Alicia Beltran, a case that practically defies belief:

Alicia Beltran cried with fear and disbelief when county sheriffs surrounded her home on July 18 and took her in handcuffs to a holding cell.

She was 14 weeks pregnant and thought she had done the right thing when, at a prenatal checkup, she described a pill addiction the previous year and said she had ended it on her own — something later verified by a urine test. But now an apparently skeptical doctor and a social worker accused her of endangering her unborn child because she had refused to accept their order to start on an anti-addiction drug.

Ms. Beltran, 28, was taken in shackles before a family court commissioner who, she says, brushed aside her pleas for a lawyer. To her astonishment, the court had already appointed a legal guardian for the fetus.

Think about that for a minute: a grown woman was shackled and taken into custody because her doctor disapproved of what she (erroneously) thought she was doing. It could never have happened but for the fact that Beltran was pregnant. Apparently, she lost her autonomy the moment the egg met the sperm.

Why did this happen at all?

Under a Wisconsin law known as the “cocaine mom” act when it was adopted in 1998, child-welfare authorities can forcibly confine a pregnant woman who uses illegal drugs or alcohol “to a severe degree,” and who refuses to accept treatment.

Now, with Ms. Beltran’s detention as Exhibit A, that law is being challenged as unconstitutional in a federal suit filed this month, the first in federal court to challenge this kind of fetal protection law. Its opponents are hoping to set an important precedent in the continuing tug of war over the rights of pregnant women and legal status of the unborn.

Why does this law exist? It’s certainly not because it is effective in protecting children:

In 2011, the American College of Obstetricians and Gynecologists said that “incarceration and threat of incarceration have proved to be ineffective in reducing the incidence of alcohol or drug abuse” and that mandated testing and reporting lead women to avoid prenatal care that “greatly reduces the negative effects of substance abuse during pregnancy.”

Dr. Cresta W. Jones, an obstetrician and a fetal medicine specialist at the Medical College of Wisconsin who sees many women with histories of drug or alcohol abuse, said that even sporadic detentions had sowed fear.

“The women are scared to come in if they have dependency problems,” she said. “When you allow them to be honest you get better outcomes in their pregnancies.”

This law and laws like it are almost surely unconstitutional and violate the basic principles of medical ethics. They exist not because anyone wants to promote the best interests of an individual child, but as a shot across the bow in the effort restrict legal abortions; these laws substitute religious principles for both medical ethics and the law, and award personhood to embryos and fetuses. Indeed, this law went so far as to appoint a lawyer for the fetus, while not providing one for its mother.

Placing the purported best interests of the child above maternal autonomy, whether in the realm of drug use or the realm of homebirth poses more than a theoretical threat to the rights of pregnant women. Homebirth may be unsafe (as a variety of legal choices like smoking may be unsafe), but women, even pregnant women, have the right to make unsafe choices. The alternative is incarcerating women against their will when they make decisions with which their doctors disagree. This alternative is both ineffective and harmful, as well as unethical and unconstitutional.

You may recall that last fall the American Journal of Obstetrics and Gynecology published a position paper opposing homebirth and I savaged it (You heard it here first: new paper opposing homebirth is poorly researched, relies on bad studies and is woefully paternalistic).

The paper in question is The paper is Planned home birth: the professional responsibility response by Chervenak et al.

Chervenak is presenting a personal, religious philosophy on maternal autonomy and fetal beneficence and it would have been appropriate for him and his colleagues to acknowledge that their views are not supported by the mainstream medical ethics community. Simply put, in light of American law, and non-religious moral ethics, Chervenak et al. are wrong about the extent of women’s autonomy and women’s ethical obligations toward their unborn children.

And:

Women’s well established right to medical autonomy is not “rights-based reductionism”; it is a foundation of medical ethics. Professional responsibility never involves forcing patients into doing what you recommend or harranging them for failing to follow your recommendations. Professional responsibility requires informed consent, nothing less and most certainly, nothing more.

Chervenak et al. have now taken their incorrect and misguided argument to the journal Pediatrics. In a paper entitled Planned Home Birth: A Violation of the Best Interests of the Child Standard?, Chervenak actually has the temerity to accuses the AAP of violating ethical standards in their position statement on homebirth, published earlier this year.

The AAP statement correctly states that hospital birth is the safest form of birth. However, the effect of this statement is to sanction, and unintentionally enable, planned home birth if certain circumstances are met. However, meeting these circumstances does not eliminate the preventable, increased perinatal risks of planned home birth. The AAP should consider withdrawing
this sanction and replacing it with the professional responsibility of pediatricians to be strongly directive in recommending against planned home birth and recommending in favor of planned hospital birth. The AAP should also emphasize the professional responsibility of pediatricians not to participate in planned home birth, except in the very limited circumstances described in this article. Pediatricians should support creating settings that resemble home birth in the hospital and in birthing centers that are in or adjacent to hospitals.

Once again, Chervenak et al. are spectacularly wrong are wrong about the extent of women’s autonomy and women’s ethical obligations toward their unborn children.

Not surprisingly, the American Academy of Pediatrics (AAP) has responded sharply to the accusation, Policy Statement on Planned Home Birth: Upholding the Best Interests of Children and Families written by Kristi Watterberg on behalf of the Committee on Fetus and Newborn.

The arguments made by Chervenak et al regarding the “best interests of the child” have several notable flaws. First, before delivery, the fetus is not an independent being (child), but a fetus, and the authors inexplicably ignore both the ethical principle of autonomy for the expectant mother and the difficult balance of maternal and fetal benefits and harms. Previous commentary by these authors advocates overriding both maternal and fetal rights, arguing instead for the “professional responsibility model of obstetric ethics … In other words, it appears that physician beneficence is the dominant ethical principle, and that when a pregnant woman becomes an obstetric patient she gives up her autonomy and her decision-making capability to the physician…

Watterberg concludes:

…[W]e firmly believe that the policy statement on planned home birth follows the AAP mandate to promote the best interests of children and their families, by acknowledging maternal and family autonomy and the complexity of their decision-making, by setting rigorous standards for care of infants born in any setting, and by promoting increased professional collaboration and communication.

Watterberg is correct.

Chervenak et. al, in addition to being wrong about the ethical principles that govern a woman’s right to choose homebirth,  appear to believe that they speak for most obstetricians when the reality is the opposite. Most obstetricians recognize that both medical ethics and the law requires that a woman’s decision to choose homebirth must be respected.

Chervenak and colleagues are certainly entitled to their personal opinions, but that’s all they are, merely their personal opinions. It is deeply unfortunate that they have chosen to mistake their personal beliefs for the ethical principles that govern contemporary medical practice.

When I first read about the new study that shows that breastmilk sold through unregulated arrangements has a high rate of contamination, I wondered how lactivists were going to handle the issue. Frankly, I thought they were going to ignore it, since it has nothing to do with breastfeeding one’s own baby.

But I was wrong. They freaked out and the freakout tells us quite a bit about lactivists and their fantastical thinking about breastmilk.

The study, Microbial Contamination of Human Milk Purchased Via the Internet, was published online yesterday by the journal Pediatrics. The authors found:

Most (74%) Internet milk samples were colonized with Gram-negative bacteria or had >104 colony-forming units/mL total aerobic count. They exhibited higher mean total aerobic, total Gram-negative, coliform, and Staphylococcus sp counts than milk bank samples. Growth of most species was positively associated with days in transit, and negatively associated with number of months since the milk was expressed, per simple linear regression. No samples were HIV type 1 RNA-positive; 21% of Internet samples were cytomegalovirus DNA-positive.

CONCLUSIONS: Human milk purchased via the Internet exhibited high overall bacterial growth and frequent contamination with pathogenic bacteria, reflecting poor collection, storage, or shipping practices…

Lactivists could have pointed out the obvious: any time you have an unregulated trade in bodily fluids (think blood, or donor sperm), you run a great risk that the fluid will be contaminated with infectious agents, may pick up bacterial contaminants, and will spoil when not frozen properly. When it happens with blood, we don’t flip out an insist that those who point it out are attempting to smear blood transfusions. When it happens with with donor sperm, we don’t flip out and condemn sperm donation. We simply implement regulations that require testing of the fluid and mandate proper freezing procedures.

So why didn’t lactivists point out the obvious? Why did they freak out instead? As far as I can tell, it’s because they can’t handle the thought that breastmilk isn’t magical.

The reaction of Allison Dixley, self-proclaimed Alpha Parent, is typical of the hysterical response:

The DFFs [Dumb Formula Feeders] are lapping it up. However the study is little more than a red herring. Sure, breast milk contains bacteria (news flash: it’s meant to!) Notice the story says “Some bacteria may not be harmful” and then goes on to say: “but salmonella is among germs that could pose a threat to infants”

To this, I reply:

http://www.ncbi.nlm.nih.gov/pubmed/18171262

Consider that formula is not designed to carry bacteria yet often carries a wide variety of potentially harmful ones.

Consider that formula contains none of the antibodies that help to counterbalance any iffy bacteria content.

Consider that formula is as prone to contamination (if not moreso through human error and longer preparation chain) as breast milk.

Consider also that mother to mother milk sharing (which this ‘study’ warns against) removes control from medical professionals (the very same medical professionals which carried out this study).

This story may be great DFF fodder, but it contributes little to improving the welfare of babies. The infant feeding hierarchy remains: direct breastfeeding from mom > pumped milk from mom > trusted wet nurse > pumped milk from trusted donor > formula.

Hey, Allison, you didn’t include “pumped milk from unknown donors being paid for it,” which is actually what we are talking about.

And Allison, you might want to go back and review your 4th grade math. When discussing the relative risk of bacterial contamination between breastmilk and formula, we must look at RATE. You remember: the number of incidents over the total number of events. Yes, powdered formula can get contaminated with harmful bacteria, too, but the rate of that happening is so low that when it does, a scientific paper is needed to alert people to it. In other words, it is quite rare. In contrast, this breastmilk study found a harmful virus contamination rate of 21%.

Why is Allison so furious? Apparently because it has been pointed out that breastmilk is not magical and is subject to the exact same concerns that apply to any bodily fluid.

Even some medical professionals manage to miss the point. Alison Stuebe, MD, MSc of the Academy of Breastfeeding Medicine reacts as if the truth that breastmilk is a body fluid like any other is some sort of plot to undermine breastfeeding.:

“Breast milk as bacterial brew” pushes lots of cultural buttons — from the “ick factor” to our reliance on mass-produced and marketed substitutes, rather than women, to nourish our children. Let’s stop pressing buttons, and start looking for solutions, so that more families can achieve their infant feeding goals.

Really?

Why are lactivists so quick to assume that pointing out the obvious about breastmilk is an attack on breastfeeding?

Partly it’s because lactivists view anything that doesn’t validate their belief that breastmilk is always superior as an attack on breastfeeding. But mainly, the hysteria comes from the threat to their own self-esteem. If breastmilk (even improperly stored, contaminated breastmilk) is just a bodily fluid subject to the same principles as other bodily fluids, it isn’t magical. I guess they worry that if it isn’t magical, the fact that breastfeeding isn’t the “superpower” they claim, and just another thing that some mothers do and other mothers don’t.

And that goes for the whole idea of milk sharing as well. It boggles my mind that any mother would give her child the unscreened, possibly contaminated bodily fluid of a stranger that she bought on the internet. The reality is that the benefits of breastmilk are trivial and hardly worth the risk. Indeed, there is no evidence of any kind that infants derive any benefit from the frozen breastmilk of strangers. Yet women have been so brainwashed by the fantastical claims of lactivists that they actually believe they are providing something valuable to their infants.

What’s the take away message from the Pediatrics study? The message is “don’t buy unregulated breastmilk over the internet.” That’s it. It has no implications for breastfeeding at all.

What’s the take away message from the lactivist hysteria over the study? The message is that these women cannot think rationally about breastmilk.

Natural childbirth and homebirth advocates go through memes like water. If one ridiculous meme doesn’t work (“obstetricians don’t follow the scientific evidence“), they just try another (“women think childbirth is painful because that’s the way it’s portrayed in the movies or on TV“).

The latest meme is “a healthy baby isn’t enough.” Consider recent pieces like these: A good birth experience is more than the baby being delivered alive, and Saying At ‘Least the Baby Was Born Healthy’ Isn’t Enough When It Comes to Birth.

The centerpiece of the “argument” is this:

But the fact that the mother and baby are still alive isn’t the only thing that matters. Certainly not in 2013, when birth is safer than it’s ever been: today, the risk that either you or your baby won’t make it is minute. So how come we’re still setting such a low bar for our ideas of whether childbirth was successful? And what damage is that doing to our children?

These questions are at the heart of a campaign launching today that calls for a rethink on what matters most in childbirth in the western world in the 21st century. Childbirth charity Birthrights is calling for a reappraisal of how we judge a successful birth: no longer should it be merely about physical health, but about psychological health as well…

I can see the point of the natural childbirth complainers. When birth is viewed as a piece of performance art where the mother is the star, the baby is irrelevant. When the baby is nothing more than a prop, who cares whether it makes it through the birth with all its brain cells intact? It’s certainly not compensation enough for being robbed of the chance to be an enact a romanticized view of the perfect birth.

Before we go any further, let me make one thing absolutely clear. I am not justifying or excusing anything less than respectful treatment of all women and informed consent for everyone. But the people most in need of greater respect and higher quality informed consent are not the privileged young, white, English speaking, relatively well off women who choose natural childbirth. The people most likely to be treated disrespectfully by the existing system are people of color, the poor, those for whom English is not their native language, the mentally handicapped and the elderly. If natural childbirth advocates really care about improving the treatment of patients, that’s where they’d start, not with their personal, trivial disappointments (“Ohmigod, ohmigod, the nurse bathed my baby outside my presence!”).

I’m going to go out on a limb here and suggest that this meme is going to be even less successful than the inane memes that proceeded it. Why? Because this meme exposes the ugly truth about natural childbirth: that’s it’s about process at the expense of outcome. In certain circles (Western, white, relatively well off women from first world countries), natural childbirth is a status symbol no different from a Prada handbag. It is something to wave about to boost fragile self esteem among ones peers.

Once you realize that, you can see exactly where these women are coming from. And you can anticipate exactly how they will react when their performance art is not appreciated or valued in the way that they value it. Criticize a woman for boasting about a Prada handbag, and odds are that she will retort that you are jealous. Criticize a woman for boasting about a natural childbirth and odds are that she, too, will retort that you are jealous. Both will have missed the point entirely.

The meme exposes another truth about natural childbirth advocates. They are implicitly acknowledging that modern obstetrics offers the safest possible birth and that they cannot compete on safety. Therefore, they’ve retreated to insisting that there is more to birth than safety. No doubt there are women who believe that, but they are few. Most women who might be attracted to natural childbirth’s promises that natural birth is a safer birth aren’t going to be impressed with the claim that a good birth experience is more important than safety. Indeed, they are likely to be horrified.

An implicit acknowledgement that modern obstetrics, with its monitoring and interventions, is safer does much to reduce the guilt of women who have a C-section or an epidural. If it’s safer to have a C-section, there’s no reason to feel guilty. If there is no safety advantage to refusing an epidural, there’s no reason to feel guilty about choosing an epidural.

In many ways, the meme that there’s more to childbirth than a healthy baby is an admission of failure on the part of natural childbirth advocates. They’ve given up the high ground of safety, and have settled on a poor defensive position of touting process over outcome. It is an acknowledgement of both of reality and of defeat.

I’m embarrassed to admit that it took this long for me to figure it out: The Alpha Parent is a parody!

You know, for a while there Allison Dixley had me going. But then I realized no one could really be that obnoxiously sanctimonious about something as trivial as breastfeeding or that exquisitely vicious toward women she claims she wants to support. She’s just satirizing militant lactivists by taking their tactics to absurdity.

Wait, what? What do you mean it’s not a parody? Surely you jest!

Do you mean to tell me that Dixley, who portrays herself in her logo with her breast being suckled and a halo on her head, is so insecure that she publicly pats herself on the head for a basic biological function she is fortunate to have no trouble accomplishing? Is she equally proud of herself for having a pancreas that makes it possible for her to regulate her blood sugar without supplemental insulin?

Are you saying that her cunningly honed viciousness accurately represents the way she feels? But that’s pathological!

You mean the woman spends hours creating text and artwork to deliberately wound other mothers? Remember when she wrote this?

Breastfeeding is like Marriage. You can’t cheat on it and expect it to work.

Do you mean she seriously views women who combo feed as cheating on their babies? Or more accurate, she hopes they view themselves as unfaithful?

Or how about when she depicted a bottle of formula in one of those emergency fire alarm boxes, with the caption “Break Glass in Emergency”? Does she really think formula is only appropriate in emergencies? Or is she simply trying to tear down women who use formula?

Consider today’s gem:

I thought that she was just trying to illustrate the post I wrote earlier today, when I explained:

… Cognitive dissonance makes it impossible for lactivists to contemplate the high frequency of breastfeeding difficulties because, according to their way of thinking, breastfeeding is natural, therefore breastfeeding is good, therefore breastfeeding works perfectly. When confronted with women who have breastfeeding difficulties, lactivists face two choices. Either they can acknowledge that natural is not always best or they can pretend that women who are having problems with a natural function are doing it wrong or not trying hard enough.

I figured she was just trying to help me out by illustrating the absurd belief that there are no legitimate reasons for not breastfeeding. And now you’re telling me that she actually believes it?

Wow, I’m shocked. Apparently Dixley gets her jollies by mentally torturing mothers who make different choices than she does. Apparently her self esteem is so pathetically low that she can only feel good when tearing others down.

But then I guess she’s doing what comes naturally to her … being a jerk.