Breastfeeding is a signifier of social status.

In every society the privileged attempt to distance themselves from those less fortunate. Privileged women adopt status displays that are costly, and therefore difficult for less privileged women to emulate.

For example, when poor people were thin because they didn’t have enough to eat, being overweight was a status display. When economics change, status displays change. Now when achieving and maintaining a thin, muscular body requires access to healthy food and gym memberships, being thin is a status display.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]European formula and donor breastmilk allow privileged women who can’t breastfeed to still display their status.[/perfectpullquote]

Infant feeding is no different.

It is not a coincidence that in wealthy, industrialized countries breastfeeding is more common among those with higher socio-economic status because it requires the leisure time to do it. Women either need a partner to support them so they can stay home and breastfeed or a high paying, high status job that allows them time to pump and access to places where they can pump.

In contrast, in poor countries, where many women lack the financial resources to purchase formula, formula feeding is a status display and breastfeeding is a sign of poverty.

So what happens when privileged women cannot or do not wish to breastfeed?

There are two status displays being marketed directly to them: European formula and donor breastmilk.

Both, of course, are prohibitively expensive.

According to Yahoo Finance, domestic infant formula costs range from 9-32 cents per ounce. But that’s a fraction of the cost of domestic organic brands at $1.15 per ounce.

But those seeking status displays have turned to Europe for extraordinarily expensive formula that — in a status bonus — is difficult to access. European formulas, at $1.75 per ounce, are designer formulas.

A recent story on Parents explains:

To access European formula, American parents either need to know someone traveling overseas or order through a formula dealer.

Sure, you may be formula feeding, but by importing Holle or HiPP, you can distinguish yourself from those using Similac or, worse, the truly unfortunate mothers who must make do with store-brand formula.

Is European formula any better for babies? Not by any pediatric metric. It’s just more expensive and that is the point. It’s a status display because poor women have neither the money nor the time to access it.

But the best status display always costs the most. By that measure, sourcing and purchasing donor breastmilk truly sets you apart. It’s the bespoke equivalent.

Critically ill infants and premature babies get priority at most milk banks, but many will sell surplus milk to families whose babies aren’t hospitalized. However, it’s expensive and not always covered by insurance. For example, some milk from the Mid-Atlantic Mothers’ Milk Bank costs $4.50 per ounce, which adds up fast when babies eat as often as every two hours.

Yet there is no evidence that donor breastmilk provides ANY benefits for term babies.

The average baby drinks approximately 9000 ounces of milk in his or her first year.

Store-branded formula at 9 cents/ounce costs $820 for one year.
High end domestic formula at 32 cents/ounce costs $2,880 for one year.
Organic domestic formula at $1.15/ounce costs $10,350 for one year.
European formula t $1.75/ounce costs $15,750 for one year.
Donor breastmilk from a milk bank at $4.50/ounce costs $40,500 for one year.

There’s a price point for a broad range of status displays. Why pay $15,750 to import European infant formula for one year when you could pay $820 and get the exact same result? To display your status!

Infant feeding isn’t really about what’s best for babies; it’s about mothers and the curated image they present to their friends and on social media. Commiserating with other high status mothers over the laboriousness of importing European formula or accessing donor breastmilk is like fretting over the difficulty of finding good servants. It distinguishes you from those who are less well off and that is the point.

The Academy of Breastfeeding Medicine is now on record as supporting the deadly practice of bedsharing.

The ABM just published a revision of its sleep protocol and it amounts to little more than special pleading for a practice that kills tens of thousands of infants a year (SIDS and suffocation).

It is a stunning violation of medical ethics, placing as it does a process (breastfeeding) over an outcome (safe babies).

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]The ABM’s principal “argument” is that while bedsharing is deadly, the babies of privileged white women are immune.[/perfectpullquote]

It is also a not so subtly classist/racist screed that focuses on distinguishing its core constituency — privileged, white women — from poor women, many of whom are women of color. Indeed, it’s principal “argument” is that while bedsharing is deadly, the babies of privileged white women are immune.

I suppose we shouldn’t be surprised that the ABM’s bedsharing protocol is unethical since its mission statement is unethical.

A Worldwide Organization Of Medical Doctors Dedicated To The Promotion, Protection, And Support Of Breastfeeding

Medical ethics requires supporting the health and wellbeing of PATIENTS, not processes. Perhaps lactation physicians initially believed their own marketing slogan, “breast is best.” But over the past 20 years, the scientific literature has made several things quite clear:

1. Breastfeeding is NOT best for every baby and every mother
2. Aggressive breastfeeding promotion has such significant risks that exclusive breastfeeding has become the LEADING cause of newborn re-hospitalization
3. Lactation professionals have encumbered breastfeeding with multiple onerous practices that are dangerous and ironically don’t increase breastfeeding rates

Now, the ABM is adding its tacit blessing to a practice that is deadly. Why? Because it purportedly “supports” breastfeeding:

Overall, the research conducted to date on bedsharing and breastfeeding indicates that nighttime proximity facilitates breastfeeding duration and exclusivity… Existing evidence does not support the conclusion that bedsharing among breastfeeding infants (i.e., breastsleeping) causes sudden infant death syndrome (SIDS) in the absence of known hazards. Larger studies with appropriate controls are needed to understand the relationship between bedsharing and infant deaths in the absence of known hazards at different ages.

If we break down the careful language, we are left with this:

Nighttime proximity is associated with breastfeeding; causation is unproven. It seems that the babies of privileged women are at lower risk. We don’t really know for certain.

No matter.

The ABM’s justification for its unethical stance is rationalized in two ways: anthropological and classist/racist.

The anthropological rationale is — not to put too fine a point on it — academic bullshit:

The concept of “breastsleeping” was proposed to describe a biologically based model of sustained contact between the mother and infant, starting immediately after birth, in which sleeping and breastfeeding are inextricably combined, assuming no hazardous risk factors. Described in cultures around the world, the breastsleeping mother and infant feed frequently during the night while lying in bed together, and by morning, the mother may not recall how many times she fed or for how long… The behavior and physiology of breastsleeping dyads may be different from that of bedsharing nonbreastfeeding dyads, signifying that the safety assessments for bedsharing with breastfeeding versus feeding human milk substitutes likely require different approaches.

When was breastsleeping first described? In ancient Egypt? In the Middle Ages? By anthropologists in the early 20th Century? No, no and no.

It seems that breastsleeping was first described in 1992 by — surprise! — a lactation professional. As far as I can determine, it does not appear in the anthropology literature to this day, although many of the lactation professionals who promote it are anthropologists by training.

The classist/racist special pleading is even more disturbing.

The ABM acknowledges that bedsharing dramatically increases the risk of infant death but rationalizes a special standard for the babies of privileged women, by and large white women. Indeed throughout the protocol there are strenuous attempts made to distinguish privileged white women from everyone else.

SIDS is most common among low-income and some marginalized communities in wealthy countries, with the world’s highest prevalence of SIDS occurring among U.S. American Indians/Alaskan Natives (combined) and non-Hispanic blacks …

And:

These are factors that increase the risk of SIDS and fatal sleeping accidents, either alone or when combined with bedsharing.
• Sharing a sofa with a sleeping adult (“sofa-sharing”)
• Infant sleeping next to an adult who is impaired by alcohola or drugs
• Infant sleeping next to an adult who smokes
• Sleeping in the prone position
• Never initiating breastfeeding
• Sharing a chair with a sleeping adult
• Sleeping on soft bedding
• Being born preterm or of low birth weight

Wealthy white women don’t sleep on sofas. Wealthy white women don’t smoke. Wealthy white women have a low rate of preterm birth. I could go on, but you can probably see the pattern.

The ABM concludes:

Accidental suffocation death is extremely rare among bedsharing breastfeeding infants in the absence of hazardous circumstances …

That’s just another way of saying “accidental suffocation death is rare among breastfeeding infants of privileged white mothers.”

And for the Academy of Breastfeeding Medicine, privileged women and their babies seem to be the only ones who count.

The benefits of breastfeeding for term babies in industrialized countries are trivial. So why is there is panic around breastfeeding rates? Because breastfeeding functions as a class signifier. It’s not about what a baby needs; it’s about a mother and how she wishes to present herself to other women.

I’m not the only person who thinks so. A new paper, When is the breast best? Infant feeding as a domain of intrasexual competition, makes a similar case.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Dominant women adopt displays of status that are costly and thus difficult or impossible for lower-status women to emulate.[/perfectpullquote]

[B]reastfeeding or not breastfeeding can serve as a means of displaying status within the context of intrasexual competition. We argue that dominant (i.e., wealthy) women are likely to adopt … displays that are costly and thus difficult or impossible for lower-status women to emulate.

What do they mean by intrasexual competition?

…[W]omen (and/or their families) pay a dowry to their husband upon marriage in highly stratified societies… This is suggested to be a domain of female competition as it is a method to acquire a wealthy husband. Essentially, the higher the dowry … the more likely a woman will acquire a wealthy husband. An- other example of female competition that is observed in wealthy modern societies in dressing in the latest fashion trends and purchasing luxury items which depicts a woman’s wealth and can therefore threaten rival women.

It’s all about women competing with each other for reproductive success.

How does breastfeeding function as a form of intrasexual competition?

We argue that the changes in who breastfeeds under different environmental pressures can help shed important light on the possible evolutionary motives underlying of women’s competitive, reproductive, and breastfeeding choices.

In modern, wealthy countries:

…[W]ealthier and/or more educated mothers tend to have higher rates of breastfeeding than their less wealthy/educated peers… Lower-income mothers in these countries tend to acknowledge the superiority of breastfeeding over formula, but refer to a lack of social and/or financial support (i.e., an inability to stay home from work) as important reasons for why they do not invest as much in their infant via breastfeeding… [B]reastfeeding may be an evolutionarily honest (i.e., costly and hard to fake) signal of a woman’s ability to invest in her child relative to other women.

But in developing countries, the opposite is true:

…[W]omen in developing countries reported that the use of infant formula is viewed as more prestigious and breastfeeding is associated with poverty. In other words, providing formula may be a social signal of a mother’s prestige and wealth in developing countries because the aforementioned cost of infant formula and the scarcity of good water serve as honest signals of a woman’s capacity to invest in her offspring.

How about pre-modern cultures?

..[T]he invention of resource inequalities allowed some women to replace their own milk with that of other mothers… the outsourcing of breastfeeding was a relatively common strat- egy among wealthier historical women in Europe and Japan (Badinter, 2012). Thus, in contrast to some general suggestions that wealthy women will generally choose to invest heavily in their offspring, there is evidence that some wealthy women have historically done the opposite …

All these cases represent a departure from the behavior of hunter-gatherer cultures where all children were breastfed by their mothers.

What has led to the changes? Intrasexual competition.

What should be a simple decision to provide one’s child with the best nutrition available instead becomes both a decision about life history resource allocation (e.g., sacrificing time, energy, and future employment opportunities) and a statement to other women about one’s capacity to make those sacrifices to make one’s child more competitive…

In contrast, in less developed and/or in historical societies, women may be able to outcompete other women via fecundity if they possess sufficient resources. Not breastfeeding one’s infant for a prolonged period removes lactational amenorrhea, allowing for a reduced interbirth interval. If a wealthy mother can afford a reasonable substitute for breastmilk (e.g., formula or wet nurses), then she can increase her relative reproductive success by physically investing less in each infant and instead investing in having more offspring.

The authors conclude:

The extant literature of the historical and cross-cultural (specifically developed vs. developing countries) practices of breastfeeding provides important insights into women’s decisions of whether or not to breastfeed. From a feminist perspective, the variation in breastfeeding practices highlights the agency of women in controlling their own body for their own benefit (albeit through their offspring)…

Instead of insisting “breast is best,” we should be supporting women to make the choice that is best for them and their family.

Although it may be impossible to completely eliminate evolutionarily predisposed comparisons of who is a better mother/woman, or whether/when breast is the best, we would much rather see individual and societal energy focused on supporting informational and practical practices that help women freely choose the best options for themselves and their infants.

Her baby, her body, her breasts, HER choice!

The principle is called Occam’s Razor.

It is sometimes paraphrased by a statement like “the simplest solution is most likely the right one” …

The Wikipedia article notes that possible explanations can become needlessly complex.

It might be coherent, for instance, to add the involvement of leprechauns to any explanation …

Those complex explanations are — revealingly — saving hypotheses.

These are special purpose hypotheses that are typically used to save a theory from being falsified by an observation.

For example, when you find your preschooler next to a vase that has fallen off a table, you will likely conclude that the preschooler knocked the vase over. The preschooler, however, may insist that bad men broke into the house, threw down the vase, and left; he was just trying to save the vase from the bad men. The principle of Occam’s Razor means that the simpler explanation (the preschooler knocked over the vase) is far more likely than the elaborate yarn he has spun.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]The simplest explanation — insufficient breastmilk — explains everything every step of the way.[/perfectpullquote]

Similarly, the principle of Occam’s Razor suggests that the elaborate yarn Milk Matters UK has spun about starving Baby H is unlikely compared to the simple explanation that the baby starved because of insufficient breastmilk.

I wrote about Baby H last week. According to Milk Matters UK, the organization run by lactation consultant Charlotte Young (the Analytical Armadillo):

Meet H, a nearly 9 week old baby we met this weekend. H is just back at slightly above the weight at which they were born; we’ve plotted their birthweight and last weight into a growth chart, to give you a visual representation …

How did this horror happen?

[O]ne midwife noted some concerns and suggested a feeding group, where they were told to stop expressing and supplementing, relax and just “feed feed feed”. Seen weekly at jaundice clinic, reluctant to weigh but did after mum pressure, no concerns noted.

Baby H starved for 9 weeks because no one dared admit that he was getting insufficient breastmilk and therefore no dared give him the infant formula he desperately needed. Apparently the mother intermittently ignored the professionals and fed the baby formula from a bottle.

MMUK prefers a much more elaborate explanation, one that markets their lucrative service (at $280/hour) of tongue-tie surgery. They diagnosed Baby H with tongue-tie and treated it.

What does Occam’s Razor tell us?

The simplest explanation is that Baby H was suffering because his mother had insufficient breastmilk and no healthcare professional was willing to admit it. The more complex explanation, favored by MMUK, is that the baby had a tongue-tie that made it impossible for him to take in adequate nutrition by breast or bottle. That multiple medical professionals examined the baby and no one noticed this tongue-tie. That the mother failed to notice that the baby was not able to drink from a bottle.

According to MMUK, their treatment was “successful”!

They posted these “before and after” photos:

But these photos don’t show that the baby had a tongue-tie or that the “treatment” fixed anything.

Why are there no pictures of the tongue-tie itself?

The simplest reason is that there was never any tongue-tie and pictures of the baby’s mouth before and after would make that clear. MMUK has offered no explanation as to why they failed to show the “tongue-tie” that multiple other medical professionals ostensibly missed.

Instead MMUK posted a looping 2 second gif of the baby breastfeeding.

The baby is wearing an SNS (supplemental nursing system) designed to provide milk when the mother has insufficient breastmilk.

But why would a baby who supposedly had successful tongue-tie surgery need formula supplementation?

The simplest answer is that the problem all along was insufficient breastmilk.

That’s what I noted in a post on my Facebook page:

No evidence has ever been presented that this baby had a tongue-tie, needed expensive surgery, or benefited from it.

Indeed, it appears that the problem was — and still is — insufficient milk supply.

MMUK responded:

The milk is mum’s expressed milk, she can express oodles as this isn’t her first rodeo and actually has oversupply.

Really? If the mother has an oversupply of breastmilk, why is the baby being supplemented WHILE breastfeeding?

An MMUK partisan offered this bizarre explanation:

A baby who has been unable to feed because of severe restriction will not have the energy to nurse for as long as required in order to gain weight, hence why continued supplementation is recommended until back to full health.

If the baby does not have energy to nurse effectively (though the video shows the baby nursing vigorously), the answer is to supplement the baby through a bottle. It shouldn’t take long (hours not days) for the baby to be able to nurse effectively.

What does Occam’s Razor tell us about the cause of Baby H’s starvation?

The simplest explanation is insufficient breastmilk. It explains everything at every step of the way.

But that won’t sell MMUK’s services.

The preferred MMUK explanation is a tongue-tie that multiple medical professionals failed to diagnose and for which there is no documentation. The baby was “cured” but still has problems nursing despite the “cure.” The baby is being supplemented at the breast even though the mother has oversupply.

Which sounds more likely?

Lactivists seem to have a lot of difficulty with basic reading comprehension. No matter how firmly I write — no matter how blunt I am, no matter how small and simple the words I use:

“I believe X.”

lactivists routinely respond with:

“So what you’re saying is Y.”

No, if I wanted to say Y, I would say it and I didn’t say it.

Part of the problem is that lactivists love the strawman fallacy:

You misrepresented someone’s argument to make it easier to attack.
By exaggerating, misrepresenting, or just completely fabricating someone’s argument, it’s much easier to present your own position as being reasonable, but this kind of dishonesty serves to undermine honest rational debate.

It’s very difficult to rebut most of the arguments I make about breastfeeding. That’s why lactation professionals don’t even bother to try. Lay lactivists strenuously attempt to misrepresent my arguments instead since it is easier to rebut the misrepresentations.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]If p then q; if not q then not p.[/perfectpullquote]

But the bigger problem for most lay lactivists is that they don’t understand basic logic. They don’t understand how conditional statements, (if p then q), are constructed and what they mean.

The most common conditional statement I make, the one that undergirds most of what I write about breastfeeding is this:

IF breastfeeding had the benefits claimed for it (If p)

THEN we should see a drop in term infant mortality, severe morbidity and healthcare costs when breastfeeding rates rise. (then q).

According to the rules of basic logic, if the conditional statement (if p then q) is true the contrapositive (if not q then not p) is also true.

The contrapositive is this:

IF we don’t see a drop in term infant mortality, severe morbidity and healthcare costs when breastfeeding rates rise (Not q)

THEN breastfeeding doesn’t have the benefits claimed for it. (then not p).

It’s pretty simple: If p then q. If not q then not p.

It’s basic logic.

Instead of responding to the straightforward argument, lactivists prefer bizarrely illogical claims.

1. You hate p! (You hate breastfeeding!) I don’t, but even if I did, that doesn’t change the truth of the underlying statements.

2. Corporations profit from r! (Corporations profit from formula!) Maybe so, but r has nothing to do with if not q then not p. The fact that companies profit from formula does not change the fact that if the predicted benefits of breastfeeding don’t occur, then breastfeeding doesn’t have those benefits.

3. You’re being paid by the folks from r! (You are being paid by formula companies!) This is just a variation of 2. I’m not being paid by anyone, but even if I were, that would not change the fundamentals of basic logic: if p then q; if not q then not p.

4. You want everyone to use r! (You want everyone to formula feed). This is yet another variation of 2. It’s particularly illogical. Why should I care? I breastfed my four children. It also tells us nothing about p and q.

5. But 100% of women aren’t engaged in p! (But not all women breastfeed!). Makes no difference. If p then q does not require a specific proportion of people to be engaged in p.

6. But the World Health Organization says p always leads to q! (But the WHO says breastfeeding has lots of important benefits!) Basic logic is not dependent on authorities and can’t be changed by the pronouncements of authorities.

7. But I love p! (But I love breastfeeding!) Maybe so and perhaps p is a significant source of self-esteem because you believe if p then q. But that doesn’t change the rules of basic logic, either.

The bottom line is pretty simple: if p then q; if not q then not p. If we can’t find the benefits claimed for breastfeeding, it doesn’t have those benefits.

If you want to rebut my arguments, you need to find evidence that the predicted benefits of breastfeeding actually occur when breastfeeding rates rise in large populations.

If you wail that I hate breastfeeding or that the WHO claims breastfeeding has benefits, or that I must be on the take from formula companies you haven’t merely failed to rebut my argument, you’ve failed to understand basic logic.

Earlier this week I wrote about a baby suffering from breastfeeding starvation for 9 weeks.

The poor baby — living in a country where copious infant formula and the clean water to prepare it are easily available — nonetheless looks like a famine victim. His arms are stick thin and his ribs are showing.

The baby is a victim of the torture known as breastfeeding promotion. Lactation professionals have put their beliefs and goals ahead of the wellbeing of babies.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Why no pictures of the tongue-tie? Could it be that the baby didn’t have one?[/perfectpullquote]

As Milk Matters UK the organization run by lactation consultant Charlotte Young (the Analytical Armadillo) acknowledged, the baby’s mother had frantically consulted multiple NHS professionals (and possibly private professionals as well) for weeks. Despite this, the baby was DENIED the EMERGENCY TREATMENT — food — he needed to relieve his ongoing torture. It would have been incredibly easy to give this baby formula either by bottle or by NG tube if he couldn’t suck effectively.

Instead, professionals exploited this baby to promote their philosophical goals.

[O]ne midwife noted some concerns and suggested a feeding group, where they were told to stop expressing and supplementing, relax and just “feed feed feed”. Seen weekly at jaundice clinic, reluctant to weigh but did after mum pressure, no concerns noted.

The baby continues to be exploited, now by Milk Matters UK, attempting to market their expensive services. If you have any doubts about their priorities, their Facebook page helpfully leads with the services:

Their primary, and apparently most lucrative service (at $280/hour) is the diagnosis and treatment of tongue-tie … and this baby received the diagnosis and treatment.

In case you think this isn’t about marketing their lucrative services, just 6 hours ago, Milk Matters UK edited the post to highlight the diagnosis of tongue-tie and to claim — deceptively — that the baby was not exclusively breastfed. The professionals INSISTED that the baby should be exclusively breastfed; the mother intermittently ignored them (and by so doing may have saved the baby’s life).

Milk Matters UK posted pictures taken at the the follow up appointment (almost $100 for 30 minutes).

Did anyone notice what they haven’t posted? There are no pictures of the supposed tongue-tie and no pictures of the results of treatment.

Why not?

Could it be that the baby didn’t have a visible tie and didn’t need any treatment, let alone surgery?

If so, it would hardly be the first time. A recent study in JAMA Otolaryngology found nearly two-thirds of cases (62%) of tongue-tie surgeries recommended by lactation consultants are unnecessary.

The press release explains:

Despite a lack of medical literature linking the surgery to improved breastfeeding, the number of these procedures has been rapidly rising in recent years, the authors point out, noting that the Kids’ Inpatient Database in the United States estimated a 10-fold increase in tongue-tie surgeries from 1,279 in 1997 to 12,406 in 2012…

The researchers examined 115 newborns who were referred to the clinic for tongue tie surgery with a pediatric ENT. There, each mother-newborn pair met with a pediatric speech-language pathologist, who performed a comprehensive feeding evaluation including clinical history, oral exam and observation of breastfeeding. They then offered real-time feedback and strategies to address the hypothesized cause of their breastfeeding challenges.

Following the multidisciplinary feeding evaluation, 62.6 percent of the newborns did not undergo the surgeries.

And even among the babies who did ultimately need surgery, nearly all were misdiagnosed or underdiagnosed by the referring lactation consultants:

Although all of the referrals were for tongue tie surgery specifically, 10 (8.7 percent) underwent a lip tie surgery alone and 32 (27.8 percent) underwent both lip and tongue tie surgery.

This is a dramatic example of the fact that breastfeeding is an industry that seeks to increase their profits by lucrative “diagnosis” of breastfeeding problems. To a hammer, everything looks like a nail. To a lactation consultant, everyone looks like they can benefit from breastfeeding “support” and “treatment.”

New parents should know that the diagnosis of tongue-tie has exploded without any evidence that the underlying rate of tongue-tie has changed. Most studies have not yielded objective evidence that surgery improves breastfeeding and most babies recommended for surgery by lactation consultants do not need it.

As for Milk Matters UK, without pictures of the supposed tongue-tie and pictures post treatment, there’s no reason to believe that the $380 spent so far did anything other than enrich those who recommended it.

I came across an extraordinary Facebook post yesterday.

It is extraordinary for four reasons:

1. A baby has been starved nearly to death in an effort to promote breastfeeding.

According to MilkMattersUk, the organization run by lactation consultant Charlotte Young (the Analytical Armadillo):

Meet H, a nearly 9 week old baby we met this weekend. H is just back at slightly above the weight at which they were born; we’ve plotted their birthweight and last weight into a growth chart, to give you a visual representation….

How did this horror happen?

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Leah Drexler, Yashed LC, PRIVATELY acknowledges babies are starving, but PUBLICLY denies it.[/perfectpullquote]

“[O]ne midwife noted some concerns and suggested a feeding group, where they were told to stop expressing and supplementing, relax and just “feed feed feed”. Seen weekly at jaundice clinic, reluctant to weigh but did after mum pressure, no concerns noted.”

The baby was starving to death because healthcare providers apparently believed their own lies that insufficient breastmilk is rare and that all breastfeeding problems can be solved by breastfeeding harder.

Think — just for a moment — about the suffering this baby endured. He was forced to cannibalize his own body to survive 9 solid weeks of hunger.

2. Lactation professionals — who are responsible for this horror — posted the evidence because they want more MONEY.

H is a prime example of what happens when you strip maternity and child services of their budgets, staff and in some cases, the removal of the whole infant feeding team. H’s family sought private support after their concerns about growth were persistently dismissed, but never mind falling through the cracks, we’re falling off cliffs!

How could anyone be so willfully blind? This baby starved for 9 weeks because aggressive efforts to promote breastfeeding have already received TOO MUCH funding. There was no lack of support; there was TOO MUCH support for breastfeeding and not enough compassion for the suffering baby. But this — like every breastfeeding tragedy — is viewed by lactation professionals as an opportunity to promote themselves and their incomes.

3. Lactation professionals are aware that it happens ALL THE TIME and aren’t doing anything to stop it.

Look at these posts from the Facebook group LACTWORLD, a group run by Yashed LC (Leah Drexler), commenting on this starving baby.

1. These are the reasons Fed Is Best exist — as much as I hate it, first we have to prevent this from happening systematically
2. Yes we have colleagues guilty of perpetuating this and even whole health systems that desperately need to be remediated
3. These are the things that make me rate in my own outpatient/Peds clinical practice …

So lactation professionals KNOW that this is happening, see it in their own practices, are aware that even WHOLE HEALTH SYSTEMS are causing this. The follow up comments in the thread reveal other lactation professionals acknowledging infant starvation.

4. But the MOST remarkable thing about the hideous suffering that this baby endured is that Leah Drexler, who just privately acknowledged that this happens all the time went on record only 10 weeks ago PUBLICLY DENYING that infants are starving under the care of lactation professionals.

As I noted on Oct. 13, Drexler was asked by lactivists to comment on a Fed Is Best Facebook post.

Fed Is Best quoted a mother:

My baby cried for over two days in a row in the baby friendly hospital… It was just starvation. It breaks my heart to remember that.

Leah Drexler — the same LC who PRIVATELY acknowledges “we have colleagues guilty of perpetuating this” — PUBLICLY said:

STARVING KIDS DON’T HAVE ENERGY TO CRY STRAIGHT FOR DAYS IN A ROW.
They stop crying by the second day and start sleeping way. Too. Much. That’s when the high bilirubin sets in.

There’s many thing that could make a child cry continuously after birth, but lack of calories to expend is not one of them.

Kids that truly aren’t getting any food by day 2-3, you can barely get them to open their eyes …

Drexler and other lactation professionals PRIVATELY acknowledge that they are harming babies, but PUBLICLY gaslight the mother reporting the harm and the Foundation trying to stop it.

How can they live with themselves?

One of the biggest ironies of contemporary breastfeeding promotion is how UNnatural it it.

Sure, breastmilk is promoted as best because its natural, but the elaborate demands and restrictions that characterize the Baby Friendly Hospital Initiative (BFHI) are based not on what happens in nature, but on the contemporary philosophy of neoliberalism. Indeed the entire profession of lactation consultant — an expert paid for assistance — is the epitome of capitalism, not nature.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Isolating a new mother in a room by herself with no one else to care for her or her newborn is an unnatural, capitalist concept.[/perfectpullquote]

According to We Need to Talk about Family: Essays on Neoliberalism, the Family and Popular Culture:

Neoliberalism is usually defined as the expansion of economic thinking in all spheres of human activity, including the family …

The individualistic conception of selfhood central to neoliberalism accepts that an individual is both an ideal locus of sovereignty and a site of governmental intervention…

We see its impact in the BFHI that is predicated on individual maternal action and disregards the impact of the family and “the village.” As a result, contemporary breastfeeding promotion is UNnatural, harking back to a past that never existed.

For example, consider the BFHI policy of closing well baby nurseries to force women to room-in with their infants 24/7. There are NO human cultures (no historical cultures, no indigenous cultures, no cultures in developing countries) that leave women alone to care for their infants by themselves from the moment of birth.

According to Traditional postpartum practices and rituals: a qualitative systematic review:

Organized support, usually in the form of family members caring for the new mother and her infant for a specified period of time, is almost universally provided in the early postpartum period by the mother, mother-in-law, other female relatives or husband…

Organized support typically corresponds to a prescribed period of rest, during which the mother is prohibited from performing her usual household chores. In most cultures, the rest period spans between 21 days and 5 weeks, and is considered a period of vulnerability for future illness.

Isolating a new mother in a room by herself with no one else to care for her or her newborn is a modern, unnatural concept. It has nothing to do with nature and everything to do with neoliberalism and capitalism.

Consider the BFHI policy of banning formula supplements. The practice of prelacteal feeding spans time and culture. Odds are high that it reflects the fact that up to 15% of new mothers have insufficient or delayed production of breastmilk. Without supplements, those babies would have died of dehydration.

We’ve ignored these insights about supplementation, ascribing them to ignorance, in favor of our preferred belief that women in indigenous cultures breastfeed early and exclusively. Once again we’ve missed the critical difference between our indigenous foremothers and ourselves. Early supplementation of breastfeeding itself is not harmful; it looks harmful when the only available prelacteal feeds are contaminated with bacteria.

How about pacifiers? They, too, are banned by the BFHI despite the fact that they reduce the incidence of Sudden Infant Death Syndrome (SIDS). Pacifiers have been used for at least the past 12,000 years and probably far longer.

There is evidence that [pacifier] precursors have been used since the Neolithic Period to calm down children. Small balls made of fabric containing food were portrayed in paintings. Other balls made of non-perishable material persisted throughout time…

We’ve ignored the historical evidence of widespread pacifier use because lactation professionals prefer to pretend that women in indigenous cultures used their breasts as pacifiers. That comports with neoliberal fantasies about the mother as an individual actor shorn from her family, her community and the technologies of her time.

What about lactation consultants? There is no such thing as experts for hire in nature. That is an invention of capitalism. Women learned to breastfeed from family members who were invested in the wellbeing of the baby nearly as much as the mother herself. They did not pay money to self-proclaimed experts more concerned with the process of breastfeeding than the outcome of healthy babies.

In truth, supporting breastfeeding does not require banning technology; it requires providing care.

If lactivists really want to increase breastfeeding rates they’d stop trying to recapitulate the absence of technology and concentrate on recapitulating the philosophy of care: it takes a village offering a tremendous amount of help and support — including supplements and pacifiers — to breastfeed a child.

Instead of promoting the Baby Friendly Hospital Initiative, they’d be banning it.

My father died 30 years ago today.

In the picture above, he’s 60 years old, holding my second son less than an hour after his birth. That baby is now a lawyer and married. My father missed it all. He was dead less than 5 months after this picture was taken, although we had no idea at the time that the cancer that would kill him was growing wildly in his chest and had been for months.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Any illusions that I had about the practice of medicine died with my father.[/perfectpullquote]

Any illusions that I had about the practice of medicine died with him.

Many people confuse my condemnation of the pseudoscience of natural childbirth, lactivism and attachment parenting with blind support of the medical profession. Nothing could be further from the truth. I’ve seen the glaring deficiencies of medical practice up close. My father died at the hospital where I had trained, where I was on the staff, where I had convinced him to switch his medical care. He died after a major medical mistake and, but for my aggressive intervention, would have died in agony while my colleagues looked on as if there was nothing they could do to ease his suffering.

I know what bad medical care looks like, and I know how common it is.

My father had a chest X-ray on November 1, 3 months after the photo was taken, and the day after he first coughed up blood. He had a fist size cancer in the middle of his chest. I got the message as I was finishing up in the operating room and hurried to meet him at the office of the chest surgeon. I didn’t have to go very far; I simply took the elevator.

During the appointment, I listened as the surgeon explained the various grim possibilities: lung cancer, lymphoma, etc. They scheduled a biopsy procedure for two days later and the surgeon asked if my father had any questions. He had only one: How could he have a fist sized tumor in his chest if only a few months before (March) he had been in this same hospital to have bladder stones removed, and his pre-op chest X-ray had been normal? The surgeon was sympathetic; sometimes tumors could grow so fast that it they could be too small to detect even a few months previously.

The biopsy revealed adenocarcinoma with an unknown primary. In other word, the cancer was so aggressive that it had lost all the features of the organ where it originated; it might have been lung cancer, but it easily could have been a metastasis from prostate cancer, or indeed any other cancer.

At some point during those days, I thought to look at the original chest X-ray, the one that had been done routinely in March. I wanted to see if, knowing what we knew now, the cancer could be detected in its earliest stages. I went down to the radiology department and requested the film. I was an attending physician at the hospital and had worked there for years. They handed over the film without question.

It is difficult to capture the sense of shock and horror that I experienced on looking at the X-ray. The cancer had been diagnosed on the pre-op film. Ironically, the diagnosis had been very skilled. The cancer was small and indistinct on the original x-ray, but the radiologist had found it anyway and prominently noted it in the written report. I immediately called my father’s primary care doctor to ask if he was aware of this. He admitted that he had known since November 1, as had the chest surgeon. The surgeon had simply lied when he had he led my father (and me) to believe that the original chest X-ray was clear.

Why had they failed to tell my father of the cancer on his original X-ray? Every doctor had thought that the job of telling the patient belonged to someone else. The radiologist thought that the urologist would tell my father, since the urologist had ordered the x-ray. The urologist thought that the radiologist would alert my father if there were anything abnormal on the x-ray. The anesthesiologist was aware that the chest x-ray showed a small cancer, but assumed that either the urologist or the radiologist had told my father. The radiologist actually sent the urologist the x-ray report, which mentioned the cancer, but the as the urologist admitted at trial years later, he had never looked at it.

Why did the doctors lie about it? When I confronted the primary care doctor he claimed that they did it to protect my father. They didn’t want to “lower his morale.” Obviously it was because no one wanted to admit what had happened, and because they wanted to protect each other. I can’t imagine how they thought they would keep it a secret. I worked at the same hospital. I had complete access to all the records, including the X-ray, yet somehow they convinced themselves I would never look.

Despite multiple types of aggressive chemotherapy, my father died 8 weeks to the day after the diagnosis. I wish I could tell you that his last day was a revelatory experience, that I had never realized how poorly dying patients were treated. Unfortunately, I knew better, and therefore was prepared to fight on his behalf.

Oh Christmas evening my mother called me at home to tell me that my father was in agony and no one would help him. I nursed my infant son to sleep and headed for the hospital, my hospital. When I saw my father, I was appalled. He was sitting bolt upright in bed, gasping for air, and clutching his chest.

I paged the intern myself and demanded his presence. The intern, to his credit, was abashed. He acknowledged that my father was clearly in terrible distress, and we agreed that morphine would ease his agony, but the intern refused to order the morphine because it “might hasten” his death.

My father was dying. Every treatment had failed and there was nothing left to try. There was no hope of recovery. And we were going to withhold pain medication … why? To prolong his death?

As you might imagine, I did not take “no” for an answer.

It was well after midnight at this point when the intern woke up his resident. I could hear that the resident was unwilling to order the pain medication, and I grabbed the phone. The resident insisted that he didn’t have the authority, only the oncology fellow could decide.

So I called the oncology fellow myself and woke him up. He couldn’t possibly order pain medication in this setting, because it might slow my father’s breathing and thereby hasten his death. Only the attending physician on call had the authority to issue that order.

Then I called the attending at home and woke him up. He listened and replied, “Look, Amy, I know you’re upset, but it’s the middle of the night. Why don’t we wait until morning when your father’s own doctor will be back and he can make the decision?”

By this point, I may, possibly, have raised my voice a bit, and a crowd of nurses and support personnel had gathered to watch from a discreet distance. I demanded that he appear in person to tell me to my face that he would not order the pain medication.

He relented and I handed the phone to the nurse so she could record the order. I started to relax.

The nurse hung up the phone and I looked at her expectantly.

“I can’t give that morphine,” she said. “I’m not comfortable with giving medication to a patient so near death.”

“You’re not comfortable?” I may, possibly, have yelled. “Not comfortable? Do I look like I care about your comfort?”

I threatened to break into the narcotics cabinet myself and get it, and then report her to the hospital administration for failing to follow an order.

She, too, relented and hung a morphine drip. Within 5 minutes my father began to ease back against the pillows. After 10 minutes, he looked at me and smiled. “I feel great!” he said. “I haven’t felt this good in months. This is terrific.”

He died less than 24 hours later. Throughout the day, he kept telling everyone how wonderful he felt. The rest of my family kept thanking me for demanding what I should not have had to demand: adequate pain relief for a dying man.

And so my beloved father died in the hospital — my hospital — where they had made a dreadful mistake and where they nearly got away with denying him the pain relief that was the only thing they had left to give.

It’s been 30 years and I miss him every day. Believe me, I have no illusions about the state of contemporary medicine.

There is a gift that we could give to mothers every day, and the holiday season would be a great time to start.

What is that gift? Replace words of shaming with words of support.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Let me watch the baby while you take some time for yourself.[/perfectpullquote]

I’ve thought a lot about the concept of shame, especially in relation to the package of mothering choices known as natural parenting. It seems to me that natural parenting has not done much for children, but it has done a lot of harm to women by making them feel ashamed. Mothers have always felt guilty of course, but shame is a relatively new emotion in relation to mothering.

According to the article For Shame: Feminism, Breastfeeding Advocacy, and Maternal Guilt published in the feminist philosophy journal Hypatia. Quoting a variety of mothers who feel like “failures” because they could not breastfeed successfully, the authors explain:

…[T]hey judge themselves as deficient: bad mothers, failures. Such negative global self-assessments suggest what scholars have identified, in contrast to guilt, as shame, which “involves the distressed apprehension of oneself as a lesser creature” or “a painful, sudden awareness of the self as less good than hoped for and expected…”

We can give mothers an incredible gift for the holidays by not shaming them in the first place. Here are a few examples:

1. Epidurals

Support: I’m so glad you got relief from the pain.

Shame: You wouldn’t take drugs the entire nine months of pregnancy; why did you take them in labor?

2. C-section

Support: I’m so glad that your baby is okay.

Shame: Your C-section was unnecessary. If you had been more educated about birth, you would have known that.

3. Breastfeeding

Support: Breastfeeding is difficult. You shouldn’t blame yourself. The important thing is that your baby is thriving.

Shame: There is no such thing as “not enough” milk. And if you were in pain when you were breastfeeding, you were doing it wrong.

4. The family bed

Support: The best sleeping arrangements differ for different families and even for different children within the same family.

Shame: What do you mean you need private time with your husband? Your baby is only young once; you’ll be married to your husband for decades.

5. Baby wearing.

Support: It’s great if a sling works for you, but the baby really doesn’t care as long as she is with you.

Shame: Your baby won’t feel loved if you don’t “wear” him. And without skin to skin contact, babies suffer from stunted emotional development.

6. The all consuming nature and isolation of caring for small children

There are lots of different way to shame women about this issue: Isn’t being with your baby more important than making money? I love my baby enough to do without material things.

Or, what do you mean you need time for yourself? There is nothing that you could be doing that is more satisfying than meeting your baby’s needs.

Or, I can’t believe you leave your baby with a sitter just so you can go to yoga class for an hour.

There are a lot of different ways to support for mothers who feel isolated and temporarily overwhelmed with parenting duties, but my personal favorite is this:

Bring the baby over to my house and I’ll watch him while you take a little time for yourself.

Happy Holidays!