Lucy Ruddle IBCLC is exasperated because I have repeatedly used her as an example of the heartlessness many lactation consultants show to women who can’t or don’t wish to breastfeed.

I doubt she is going to be relieved that today I will use her as an example of the utter cluelessness of lactation consultants when it comes to the scientific literature. Not only do they fail to read it, but when they read it, they don’t understand it.

Yesterday Lucy gleefully wrote:

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]She read the wrong paper; misunderstood what she read; and the paper confirmed my claim.[/perfectpullquote]

So, that study being shared by certain places who like to scaremonger… the “1 in 71 breastfed newborns are readmitted” one… I got hold of it, mainly because I was interested in the limitations, which SOB and FIB have a habit of ignoring.

The first thing which I found interesting was there was a significant difference in readmission rates if the baby was delivered by C section vs Vaginal delivery. Csec babies had a readmission for weight loss rate of 6%, vs 0.4% of vaginal birth babies.

Right away we learn several things.

1. Lucy — like many lactation consultants — is not in the habit or reading the scientific literature. She knows what she knows and imagines that she can’t learn any more. She only read this paper so she could play “gotcha.”

2. Lucy had no idea which paper I referenced, she couldn’t be bothered to check the many times I had provided the citation.

The paper has this quote:

…[E]xclusive breastfeeding at discharge from the hospital is likely the single greatest risk factor for hospital readmission in newborns.29,30 Term infants who are exclusively breastfed are more likely to be hospitalized compared to formula-fed or mixed-fed infants, due to hyperbilirubinemia, dehydration, hyper- natremia, and weight loss (number needed to harm (NNH)=71).

She just guessed and chose the WRONG paper.

3. Lucy — like many lactation consultants — cannot understand the science she reads. She confused weight loss rates with readmission rates.

She read literally ignored the results section of the abstract that said this:

Exclusively breastfed newborns had higher readmission rates than those exclusively formula fed for both vaginal (4.3% compared to 2.1%) (p<0.001) and Cesarean deliveries (2.1% compared to 1.5%) (p=0.025).

It couldn’t possibly be clearer!

Instead Ruddle seized on these sentences deep in the paper:

For newborns delivered vaginally, WEIGHT LOSS >10% at discharge was rare (0.4%)… For newborns delivered by Cesarean, WEIGHT LOSS >10% at discharge occurred for 6% of newborns …

That’s an interesting finding, but those are NOT readmission rates.

4. Lucy didn’t stop to think. She assumed that she had caught me as well as the Fed Is Best Foundation in a glaring error. It apparently never occurred to her that since we have far more education and experience with scientific evidence, she ought to carefully check her own findings that disagreed so dramatically.

5. Lucy spun nonsensical theories based on her nonsensical conclusion:

So, why are C section babies more likely to be readmitted for weight loss? I’m wondering if its linked to delayed onset of copious milk production. Milk “coming in” can be delayed by 24hrs following a C section, and this may cause excessive weight loss with, or without signs of baby struggling or even being bothered by this…

But C-section babies are LESS likely to be readmitted, so her entire theory is a figment of her imagination. Why are they less likely to be readmitted? Because they stay in the hospital 24-48 hours longer while their mothers are recovering; dehydration and jaundice is more likely to be picked up and treated BEFORE discharge.

6. In the ultimate irony, the paper that Lucy read and misunderstood has a HIGHER readmission rate than 1 in 71. According to the data in the paper, the readmission rate for exclusively breastfed babies in as high as 1 in 54.

To summarize: Ruddle read the wrong paper; misunderstood what she read; never questioned why her “findings” differed so dramatically from others; spun a nonsensical theory to account for her misinterpretation; and the paper actually CONFIRMED my point by showing that even MORE than 1 in 71 exclusively babies are readmitted.

The bottom line? Don’t listen to lactation consultants if you want to know what the scientific literature shows.

Only one question remains: Will she apologize and issue a correction when she finds out how foolish she has been?

There is no question that aggressive promotion of the ideology of normal birth has led to tens if not hundreds of infant brain injuries and deaths in various hospital trusts around the UK. There is no question that midwives were excruciatingly aware that they were at fault; that’s why they hid the evidence. Yet I can’t find a single UK midwifery leader willing to take responsibility for the tragic outcomes.

There is no question that aggressive promotion of breastfeeding has led to tens of thousands of newborn re-hospitalizations at a cost of hundreds of millions of dollars each year. Lactivist organizations don’t even deny it. There is no question that babies are suffering brain injuries and deaths as a result of the policies of the Baby Friendly Hospital Initiative. Lactation professionals are well aware of it. Yet I can’t find a single lactation leader willing to take responsibility for the tragic outcomes.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Mistakes were made but not by them.[/perfectpullquote]

The reason is simple: self-justification.

To hear UK midwives tell it, mistakes were made but not by them.

To hear lactation leaders tell it, mistakes were made but not by them.

The use of the passive voice is often a give away that self-justification is the response. In and of itself, self-justification is not harmful. But it becomes harmful when — as in the case of UK midwives and lactation professionals in industrialized countries — it replaces acceptance of responsibility, learning from mistakes, and ending the harm.

According to the book Mistakes Were Made (but not by me):

As fallible human beings, all of us share the impulse to justify ourselves and avoid taking responsibility for actions that turn out to be harmful, immoral, or stupid… most of us find it difficult if not impossible to say “I was wrong; I made a terrible mistake.” The higher the stakes—emotional, financial, moral—the greater the difficulty.

It goes further than that. Most people, when directly confronted by evidence that they are wrong, do not change their point of view or plan of action but justify it even more tenaciously…

When directly confronted by the evidence that UK midwives have harmed babies, they do not change their point of view or plan of action, but justify their allegiance to normal birth even more tenaciously.

When directly confronted by the evidence that the Baby Friendly Hospital Initiative is harming literally tens of thousands of babies each year, lactation leaders do not change their point of view or plan of action, but justify their allegiance to breastfeeding even more tenaciously.

The authors note that in many cases self-justification is more dangerous than an outright lie:

It allows people to convince themselves that what they did was the best thing they could have done. In fact, come to think of it, it was the right thing. “There was nothing else I could have done.” “Actually, it was a brilliant solution to the problem.” “I was doing the best for [those I serve].” …

Self-justification by professionals is particularly harmful:

…It blocks our ability to even see our errors, let alone correct them. It distorts reality, keeping us from getting all the information we need and assessing issues clearly… It permits the guilty to avoid taking responsibility for their deeds. And it keeps many professionals from changing outdated attitudes and procedures that can harm the public.

How can we tell when healthcare professionals are deluding themselves and trying to delude the public with self-justification? We can ask a simple question: are the principles they defend falsifiable?

Science always starts with a hypothesis and then tests it to see if it is true. The possibility always exists that the hypothesis is false. If, however, the hypothesis is viewed as non-falsifiable — there is no possibility that the conclusion is wrong since they do whatever is necessary to arrive at it — it’s not science.

That’s why religion is not and can never be scientific. If you insist that God exists and no amount of evidence can change your mind, you have made the existence of God non-falsifiable and therefore unscientific.

The bedrock principle of UK midwifery is that so called “normal” birth is best for the overwhelming majority of babies and mothers. No amount of harm to babies and mothers can change their minds. UK midwives view it as non-falsifiable. That’s not science; it’s personal belief.

The bedrock principle of lactation professionals is that breastfeeding is best for the overwhelming majority of babies and mothers. No amount of harm to babies and mothers can change their minds. Lactation professionals view it as non-falsifiable. That’s not science; it’s personal belief.

It is important to understand that midwifery does not require the belief that normal birth is best for the overwhelming majority of babies and mothers. Midwives could admit that normal birth is not best a lot of babies and mothers and still provide excellent care, be gainfully employed and act on their values. But that would mean collaboration with other health professionals and giving up control of many patients. They don’t want to do either.

Breastfeeding medicine does not require the belief that breastfeeding is best for the overwhelming majority of babies and mothers. Lactation professionals could admit that breastfeeding is not best for many and still provide excellent care, be gainfully employed and act on their values. But that would reduce their scope of influence and decrease their employment opportunities. They are loathe to do either.

UK midwives and lactation professionals in industrialized countries are hardly the first medical professionals to make deadly mistakes. But mistakes become deadlier When midwives and lactation consultants refuse to learn from them and change their practice.

Can you imagine if doctors who cut episiotomies that turned out to cause the very problems they were supposed to prevent insisted that there was nothing wrong with episiotomies and they were right to cut them? Women would continue to be harmed.

Can you imagine if doctors who prescribed postmenopausal hormone replacement therapy (HRT) to reduce the risk of heart disease and inadvertently raised the risk of breast cancer insisted that there was nothing wrong with routine HRT and continued to prescribe it? Women would continue to be harmed.

We would rightfully be horrified.

That’s why we should be horrified that UK midwives are still insisting — despite the death toll — that normal birth is still best. And we should be horrified that lactation professionals are still insisting — despite the hospitalizations and neonatal injuries and deaths — that breastfeeding is still best.

Apparently, mistakes may have been made, but not by them.

I understand why maternal suffering is central to lactivism. It, like other aspects of natural mothering (natural childbirth, attachment parenting) is meant to control women. It was literally designed to subordinate women’s intelligence, talents, needs and desires to the purported “imperatives” of full time mothering.

Women’s needs and desires are therefore rendered invisible and treated as irrelevant. It’s not surprising then that maternal exhaustion is normalized, that maternal pain is ignored, and maternal needs beyond mothering are discounted. Although breastfeeding is typically portrayed with images of blissful mothers nursing milk-drunk babies, the reality is often quite different. No matter. There is literally no amount of maternal suffering — pain, exhaustion, mental anguish — that is not normalized in contemporary breastfeeding discourse.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Does supporting breastfeeding require ridiculing those who worry infants are suffering?[/perfectpullquote]

I understand that. What I don’t understand is why babies’ suffering is considered acceptable.

Lucy Ruddle, IBCLC has created the character Enid, an old busybody, to make fun of anyone who dares question aggressive breastfeeding promotion. Enid — Ruddle has acknowledged — is supposed to be me.

Enid incorporates anti-feminist, ageist tropes about older women: dry, desiccated women whose appearance is distasteful, whose experience is dismissed, who should no longer be seen or heard. I expected that. What I did not expect is how Enid is mobilized to normalize infant suffering.

This was the first Enid cartoon:

This is Enid. Enid formula fed her babies, has no training in supporting breastfeeding, and wouldn’t know a letdown from her elbow. But Enid feels qualified to say you aren’t making enough milk for your baby.

Ruddle fails to explain why you need to understand letdown in order to recognize a starving baby; you don’t. Ruddle also fails to acknowledge that I breastfed four children over many years and am professionally trained both in the physiology of breastfeeding and the physiology of newborns. But what struck me most forcefully about this cartoon is that Enid’s concern that a baby might be suffering is mocked.

Babies ARE suffering as a result of aggressive breastfeeding promotion. In the US, tens of thousands are being re-hospitalized each year for complications of insufficient breastmilk. In the UK, the re-hospitalization rate for complications of breastfeeding is so high that it has significantly raised the overall preventable re-hospitalization rate for all babies.

It’s not a figment of my imagination. And therefore, it is not a figment of Enid’s imagination that a woman intent on exclusively breastfeeding her baby might be inadvertently starving that child. After all, as Academy of Breastfeeding Medicine Board Member Alison Stuebe, MD acknowledges:

… 15% of infants — about 1 in 7 breastfed babies — will have an indication for supplementation.

In other words, there’s a 15% chance that Enid is right, the baby is starving and he or she may end up re-hospitalized if no supplementation is forthcoming. Curiously, Ruddle doesn’t merely discount that possibility, she ignores the very real suffering of babies who are being inadvertently starved. Why? Is infant suffering funny? Is infant suffering unworthy of her concern?

Today’s Enid cartoon continues in the same vein:

Enid took a casserole to her neighbor who recently had a baby … She also took a dummy [pacifier] because she heard the baby cry during Coronation St.

Imagine that. Dry, desiccated old Enid provided food for the parents because she wanted to be helpful and provided a pacifier for the exact same reason: she thought it might be helpful. Enid knows from experience that it is very hard to hear your own baby cry and new mothers are desperate to soothe their babies. Enid knows, probably from experience, that babies can be soothed with pacifiers, reducing the suffering of both babies and mothers. Enid probably doesn’t know — though I do — that pacifiers reduce the risk of Sudden Infant Death Syndrome (SIDS), the dreaded scourge of contemporary infancy.

There’s no evidence that pacifiers interfere with breastfeeding. Nipple confusion exists almost exclusively in the minds of lactation professionals and nowhere else. Babies have a natural need to suck and are soothed by sucking. Yet Lucy seems to think that babies should be deprived of pacifiers and suffer as a result. Why?

I have lots of other questions for Ruddle about the normalization of infant suffering but I’ll confine myself to this:

Does supporting breastfeeding really require ridiculing those who worry infants are suffering as a result?

It’s described as the “largest maternity scandal in NHS history.” That’s saying something in a system that has suffered massive maternity scandals like Morecambe Bay.

According to The Independent:

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Midwives and lactation professionals are copying physicians’ deadliest mistake: believing good intentions can’t cause harm.[/perfectpullquote]

Dozens of babies and three mothers died on the wards of a single hospital trust, in what is being described as the largest maternity scandal in the history of the NHS …

Clinical malpractice was allowed to continue unchecked over a period of 40 years …

The investigation singles out the deaths of at least 42 babies and three mothers at Shrewsbury and Telford Hospital Trust (SATH) between 1979 and 2017.

More than 50 children also suffered permanent brain damage after being deprived of oxygen during birth, the investigation discovered, as well as identifying 47 other cases of substandard care.

How could it happen?

Because midwives are recapitulating physicians’ deadliest mistake: believing good intentions can’t cause harm.

I’ve written about the ways in which midwives have replaced the paternalism of medicine with maternalism. They rightly excoriated doctors who thought they knew what women needed better than women themselves. Now they display a maternalism of stunning hubris, assuming that they know what women need from childbirth better than women themselves. Just like doctors who pressured, hectored and misled women into doing what the doctor ordered, midwives — through campaigns promoting “normal” birth pressure, hector and mislead women into doing what midwives want.

But that’s not the worst of it, as scandals like Shrewsbury and Morecambe Bay have made clear. The worst is the refusal to acknowledge the harm they cause and the concomitant resistance to changing the harmful behavior.

Just as in the case of Morecambe Bay, the horror at Shrewsbury and Telford can be traced to the midwives:

The subsequent review identified systemic failings by the former head of midwifery Cathy Smith, and midwives who altered notes retrospectively.

A forthcoming report identifies:

— A long-term lack of informed consent for mothers choosing to deliver their babies in midwifery-led units – where risks can be higher if problems occur – which “continues to the present day”

— A long-term lack of transparency, honesty and communication with families when things go wrong. This supported a culture that was “disrespectful” to families who had been “damaged” as a result

— Failure to recognise serious incidents. Many families who had undergone horrific experiences were told they were the only ones and lessons would be learnt. The report said: “It is clear this is not correct”

— A long-term failure to involve families in investigations that were often poor and described as “extremely brief” and “overly defensive of staff”
…
Not sharing learning, meaning “repeated mistakes that are often similar from case to case”. Failure to learn was present from the earliest case of a neonatal death in 1979 to cases occurring at the end of 2017 …

It is important to understand that this didn’t happen because the midwives wanted to harm babies and mothers. It happened — and it continued to happen — because the midwives believed their care couldn’t possibly harm babies and mothers because they had the best intentions.

Many of them believe to the core of their being that so called “normal” birth is better for babies and mothers. They confused cause and effect. Having seen that women in labor who don’t need interventions might have better outcomes than those who do, they concluded that the absence of interventions cause the good outcomes. It’s the maternity equivalent of responding to the fact that patients in the intensive care unit die at a higher rate than those on the regular floors by closing the ICU.

Midwives pledge their allegiance to “normal” birth for the purest of intentions. They thought (and many still do) that “normal” birth is better for babies and for mothers. And because they were so sure of their good will, they refused to accept the evidence of harm from their own eyes. They refused to properly investigate bad outcomes, refused to learn from them and tried to hide them. They were engaged in a passionate campaign to keep the ugly truth from themselves: their relentless promotion of “normal” birth is killing babies and mothers.

It is no different from the behavior of the colleagues of Ignaz Semmelweis, who refused to wash their hands because they passionately believed that their good intentions meant they couldn’t possibly be carrying disease. But good intentions did not prevent bacteria from being transmitted by doctors from patient to patient. Four decades and countless deaths passed before doctors were forced to acknowledge that they could cause harm despite good intentions.

And it’s no different from the contemporary behavior of lactation professionals who refuse to recognize the harm they are causing. As a result of aggressive campaigns to promote breastfeeding, exclusive breastfeeding has become the LEADING cause of newborn re-hospitalization. Literally tens of thousands of babies are re-hospitalized each year at a cost of hundreds of millions of dollars. Lactation organizations aren’t denying this; they know it’s true. But like the midwives of Shrewsbury and Telford, they are refusing to accept the evidence of harm, refusing to learn from the harm and trying to conceal the harm. They are engaged in a passionate campaign to hide the truth from themselves.

Doctors have learned the hard way that good intentions do not guarantee good or even safe care. Good intentions didn’t prevent the tragedy of DES (a hormone that was supposed to prevent miscarriage but instead gave female offspring a rare form of cancer). Good intentions did not prevent the fact that episiotomies cause the very same harm they were supposed to prevent.

Similarly, good intentions on the part of midwives do not prevent them from causing deadly harm. And good intentions on the part of lactation professionals does not prevent them from harming babies, sometimes grievously.

Belief that good intentions must necessarily lead to good outcomes is a form of professional arrogance. It’s wrong when doctors behave arrogantly and it is equally wrong when midwives and lactation consultants behave arrogantly. It’s time for midwives and lactation professionals to acknowledge that fundamental truth before they harm more babies and mothers.

Melissa Bartick, MD has a forthcoming paper in the journal Pediatrics entitled Trends in Breastfeeding Interventions, Skin-to-Skin Care, and Sudden Infant Death in the First 6 Days after Birth. She claims her data show that the Baby Friendly Hospital Initiative cannot possibly be blamed for sudden unexpected infant deaths (SUID) due to smothering during skin-to-skin care (SCC) because death rates dropped as the proportion of Baby Friendly Hospitals increased.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Dividing one unreliable number by another unreliable number cannot yield a reliable result.[/perfectpullquote]

In Massachusetts, births in Baby-Friendly facilities rose from 2.8% to 13.9% and skin-to-skin care rose from 50% to 97.8%. SUID prevalence decreased from 2010-2016 compared with 2004-2009: OR 0.32 (95% CI 0.13, 0.82).

There’s just one problem. The data show nothing of the kind because the data have been noted to be unreliable.

A chart from the paper makes it clear:

How did Dr. Bartick “calculate” that the Massachusetts SUID prevalence decreased over time? She divided one unreliable number (it is literally listed as unreliable) by another unreliable number and expects us to believe that the resulting number is magically reliable. Seriously?

This is just the most egregious misrepresentation in a paper full of them. For example, Dr. Bartick appears to be responding to the paper Trends in the Incidence of Sudden Unexpected Infant Death in the Newborn: 1995-2014 (her first reference).

That paper found:

Death records for 1995-2014 indicate that, although SUID rates in the postneonatal period have declined subsequent to the 1992 American Academy of Pediatrics sleep position policy change, newborn SUIDs have failed to decrease, and the percentage of SUIDs attributed to unsafe sleep conditions has increased significantly in both periods; 29.2% of the neonatal cases occurred within the first 6 days of life.

It’s central claim is that while SUID from 6 days of age to one year of age has decreased dramatically, SUID from birth to 6 days has not decreased and has come to represent an ever larger proportion of total SUID deaths.

So why does she restrict her paper to 2004 and after? Compare the graph she supplies of sudden deaths by year, to the one in the earlier paper and you can see why.

Her graph:

The graph from the earlier paper:

The blue line shows the prevalence of sudden unexpected infant deaths in the neonatal period. The orange line shows SUID in the postneonatal period. It’s pretty hard to argue, as Bartick is trying to do, that as the Baby Friendly Hospital Initiative in general and skin-to-skin care in particular has become more widespread, early SUID deaths have decreased.

Dr. Bartick’s use of make-believe math is the sign of a far deeper problem than math illiteracy.

Why is she resisting the existing scientific evidence in this area as well as — not coincidentally — resisting the scientific evidence that bed-sharing is deadly? Sadly, she and her lactation colleagues appear to be more interested in protecting professionalized breastfeeding support and its attendant practices than in protecting babies.

It is a fundamental violation of medical ethics to protect a process instead of protecting patients. Nonetheless, contemporary lactation professionals view their mission as protecting, promoting and supporting breastfeeding. Their ethical obligation — in contrast — is to protect babies, promoting safe infant feeding, and support mothers.

By pledging their allegiance to the process of breastfeeding instead of babies and mothers, lactation professionals are making a terrible mistake. It’s all the more mystifying when you consider that skin-to-skin care has little to nothing to do with breastfeeding itself. SSC is a method to protect premature babies in low resource settings where there is no access to temperature controlled incubators. To my knowledge, there has never been any evidence that term babies need or particularly benefit from it. Yet lactation professionals are so rigid in their thinking that they feel compelled to mindlessly defend anything that touches upon breastfeeding.

They’re hardly the first medical professionals to make a mistake by refusing to recognize the harm they cause. Most famously, in the 1840’s Semmelweis proposed hand washing to reduce puerperal sepsis and his colleagues not merely ignored him, they got angry at him.

…[D]octors were offended by the implication that they were dirty and needed to wash more, or that doctors could be somehow at fault for their patients’ demise…

Lactation professionals, like Dr. Semmelweis’ colleagues are offended by the implication that THEY could be harming babies in their aggressive efforts to protect, promote and support breastfeeding.

Semmelweis’ colleagues managed to convince themselves for several more decades that puerperal sepsis had nothing to do with them, while women died because they didn’t wash their hands. It wasn’t until the 1880’s that everyone was forced to admit that hand washing protected patients because doctors could and did carry harmful bacteria.

Unfortunately, Dr. Bartick and her colleagues are responding to the burgeoning scientific literature detailing the harms of aggressive breastfeeding promotion just as Semmelweis’ colleagues responded to his discovery. They are desperately trying to protect their egos rather than their patients.

Women tell inconvenient truths.

That leaves us with two choices: we could believe them and deal with the resulting cognitive dissonance or we could ease our discomfort by insisting, without evidence, that they are wrong.

Guess which is easier.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Women tell inconvenient truths about breastfeeding.[/perfectpullquote]

For years women have been telling inconvenient truths about sexual aggression, harassment and assault. I doubt there is a woman alive who has not been the recipient of unwanted attention, unwanted touching or unwanted attacks. The problem is not rare; it is commonplace and equally commonplace is the response: that didn’t happen; it wasn’t him; you misunderstood; you’re overreacting; boys will be boys.

The tendency to ignore women’s incovenient truths is not limited to accusations of sexual assault. For example, within medicine it is well known that women’s pain is often undertreated. When women complain of severe pain, they are often dismissed in ways that men never are: it’s not that painful; you can tolerate it; you’re overreacting; it’s all in your head.

Sadly, this tendency to dismiss women’s pain and perceptions about their own bodies is not restricted to paternalistic male doctors. It is widespread among female lactation consultants.

Women tell inconvenient truths about the difficulties of breastfeeding, the pain they experience and the fact that many produce insufficient breastmilk to fully nourish an infant. Lactation consultants, who only make money when they convince women to breastfeed, respond dismissively: you must be doing it wrong; you’re overreacting; it’s all in your head; you’re a victim of formula manufacturers; you just need more support.

Consider this meme from Lucy Ruddle, IBCLC:

This is Enid. Enid formula fed her babies, has no training in supporting breastfeeding, and wouldn’t know a letdown from her elbow. But Enid feels qualified to say you aren’t making enough milk for your baby.

Lucy seems like a decent person and I imagine this was supposed to be humorous. But it has serious — and ugly — implications. It suggests that when women report insufficient breastmilk they can be ignored since they are unwitting dupes of formula feeders.

It’s uncomfortably similar to suggesting that women who report sexual assault can be ignored since they are unwitting dupes of feminist extremists.

What do lactation consultants lose when they believe women who report insufficient breastmilk? They lose income and ideological satisfaction; that’s why they have no trouble dismissing women’s perceptions as flawed, invalid or manufactured by “Enids.” So what if it’s both disrespectful and untrue; the end — maintaining lactation consultants’ belief in the perfection of breastfeeding — purportedly justify the means.

But, as in the case of sexual assault, there are no ends that justify disrespecting and refusing to believe women. It’s just misogyny in the service of self-dealing.

 

P.S. for Lucy: Think about how my piece makes you feel — angry, misunderstood, bullied — and realize that this is how women who struggle with insufficient breastmilk feel as a result of your meme.

No doubt it is very difficult to learn that the organization that you lead, Baby Friendly USA — the organization that pays you — is completely ineffective at its central task. But that doesn’t make it acceptable to respond with fake news.

Fact vs. FIB: The Impact of Baby-Friendly on Breastfeeding Initiation Rates Is a masterful attempt to fool its lactivists and lactation professionals.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Breastfeeding rates were rising for decades before the advent of the BFHI.[/perfectpullquote]

The most recent example of data distortion is a novel but incomplete presentation of data in a study published last month in The Journal of Pediatrics, which Fed Is Best (FIB) has now leveraged into sensationalized social media posts and this erroneous and deceptive headline on its website: “US Study Shows Baby-Friendly Hospital Initiative (BFHI) Does Not Work.”

What did the study show?

Researchers could not find ANY ASSOCIATION (let alone causation) between the BFHI program and breastfeeding initiation rates and breastfeeding continuation rates.

To counter the copious data in the original study, BF USA presents this simple graph:

It appears to imply two things:

1. It appears to imply that the BFHI came BEFORE the rise in breastfeeding rates.
2. It appears to imply a dose-response: more BFHI facilities lead to higher breastfeeding rates.

But, like most fake news, it misrepresents the data — in this case by looking only at a select time period.

What happens when we take a broader view?

This happens:

The graph is from Surgeon General’s Call to Action to Support Breastfeeding 2011; I added the red markings to illustrate the point:

The BFHI came AFTER the rise in breastfeeding rates.

Since that’s the case, simply graphing breastfeeding initiation rates against the number of BFHI hospitals CAN’T tell us whether the BFHI is successful; breastfeeding rates were rising already.

So the authors looked for a dose-response. Did more BFHI hospitals in a state lead to higher breastfeeding rates in that state?

This is what they found.

You can see that increasing the proportion of BFHI facilities in a state has no impact on breastfeeding initiation rates. States with no BFHI facilities have the same breastfeeding initiation rates as those with nearly 100% BFHI facilities. The BF USA graph is fake news because it deliberately misrepresents the relationship between BFHI and breastfeeding initiation rates.

More remarkable still is that BF USA did not even try to dispute the central point of the study: that BFHI has no impact on continuation of breastfeeding.

Why is this so important?

Breastfeeding initiation rates were rising dramatically before the BFHI; women had received the message that breastfeeding has some benefits and they wanted to give their babies those benefits. However, the majority of women give up breastfeeding in a relatively short time. The study shows that BFHI has no impact on out of hospital breastfeeding rates. BF USA does not deny it.

The real problem, though, is that the BFHI is harming babies and mothers.

The authors of the study note:

…concerns about associated neonatal sentinel events including sudden unexpected postnatal collapse (SUPC), newborn falls, and newborn dehydration and jaundice, which are recognized by the American Academy of Pediatrics, the WHO, The Joint Commission, and the CDC.

Indeed, breastfeeding has become the LEADING risk factor for newborn re-hospitalization, leading to tens of thousands of re-hospitalizations a year at a cost of hundreds of millions of dollars.

BF USA has never denied this, and isn’t denying it now.

I suspect that lactivists and lactation professionals will gobble up BF USA’s misleading claims, but the rest of us don’t have to fall for fake news.

The central conceit of contemporary natural mothering is that mothering in nature (including childbirth and breastfeeding) was perfectly designed and therefore we should emulate it. The “proof” is that we are still here.

But there’s a big difference between the survival of the species and survival of individuals within the species. The reality is that nature views babies as expendable and only women who are insulated from nature by their privilege could wish to copy that.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]In Nature 27% of babies died in their first year and 47.5% did not survive to puberty.[/perfectpullquote]

One of the main characteristics of reproduction in the animal kingdom (and the plant kingdom) is massive wastage. The chance of any individual organism surviving to adulthood is very small; therefore, massive amounts of offspring must be produced because most of them are naturally going to die.

Think about how many seeds are produced by an individual plant. Think about how many larvae are produced by one insect. Think about how many eggs are produced by an individual fish. Then think about how many of those survive to become the adult form: only a vanishingly small proportion. There’s a big difference between survival of the species and survival of individuals within the species.

The classic example is the thousands of baby turtles who all hatch on a single night and immediately begin clambering across the beach to safety in the sea. Along the way they must travel a gauntlet of predators and most will not survive. There’s a big difference between survival of the species and survival of individuals within the species.

How about those animals that invest time in brooding or gestating their young? For them, parental energy expenditure is much greater and the the proportion of offspring that are lost before adulthood is consequently much lower, but it is still high.

How high?

According to the paper Infant and child death in the human environment of evolutionary adaptation:

We examine a large number of both hunter–gatherer (N=20) and historical (N=43) infant and child mortality rates to generate a reliable quantitative estimate of their levels … Using data drawn from a wide range of geographic locations, cultures, and times, we estimate that approximately 27% of infants failed to survive their first year of life, while approximately 47.5% of children failed to survive to puberty … a cross-species comparison found that human child mortality rates are roughly equivalent to Old World monkeys, higher than orangutan or bonobo rates and potentially higher than those of chimpanzees and gorillas.

This chart demonstrates the horrific infant and child mortality rates in indigenous cultures:

There’s a big difference between survival of humans as a species and survival of individual humans within the species.

How does this compare with our closest animal relatives?

[A] cross-species comparison found that human child mortality rates are roughly equivalent to Old World monkeys, higher than orangutan or bonobo rates and potentially higher than those of chimpanzees and gorillas.

In other words, astronomical rates of infant and child mortality are not merely natural, they’re quite common among primates.

Childbirth and breastfeeding aren’t “perfectly designed.” They’re relatively poorly designed. In contrast, the interventions of modern obstetrics ARE designed to save close to 100% of babies. That’s why modern infant mortality is only a small fraction of natural infant mortality.

Similarly, infant formula IS designed to save as close to 100% of babies as possible and vaccinations ARE designed to save as close to 100% of children as possible.

That’s why contemporary US child mortality is only a tiny fraction more than infant mortality.

This graph represents the dramatic increase in population that has resulted from technology:

Natural mothering advocates want to return to Nature in the Paleolithic (Stone Age) because —supposedly — childbirth and breastfeeding are “perfectly designed” and “we are still here.”

Nature views babies as expendable, subject to the exact same natural forces that kill babies of other species. The difference between humans and all other animals — the reason we have thrived and expanded to take over the planet — is NOT that humans are perfectly designed for nearly 100% survival in birth or that breastfeeding is perfectly designed to support 100% of infants. The difference is that we use technology to ensure that babies who would otherwise die will live instead.

Natural childbirth advocates who prattle that women are perfectly designed to give birth and lactivists who prate that women are perfectly designed to breastfeed successfully live in a fantasy world where “trusting” birth and breastfeeding seems to them to be an actual strategy when it is nothing more than immature, wishful thinking. The irony is that their fantasy world is made possible by the liberal use of the technologies that they deplore.

In Nature 27% of babies died in their first year and 47.5% did not survive to puberty. Those numbers are consistent with other primates. Nature views babies (and children) as expendable. Only a privileged fool would want to emulate that.

The Australian Maternity Consumer Network is mad at me!

Well, we know we’re really getting somewhere when the birth world equivalent of Woman’s Day jumps on our viral media on Birth Trauma!!

Yeah, nah thanks. The credibility of an American OB that fails to raise serious concerns about their own maternity system, is limited- American women are 50% more likely to die in childbirth than their mothers were, and black and women of colour are 4 x more likely to die.

Ignore Cochrane review into midwifery continuity of carer + WHO recommendations- polarize women by playing on their vulnerabilities. This fear based approach is to keep hoodwinking women so we won’t demand system reforms.

What does any of this have to do with birth trauma? Nothing! It’s just pathetic ad hominems from an organization that can’t rebut my claims.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Is Australia’s Maternity Consumer Network an example of astroturfing?[/perfectpullquote]

Apparently they were stung by my recent piece accusing them of leveraging birth trauma to promote industry interests.

What do I mean?

Imagine a “Breastfeeding Consumer Network” organized and run by Similac and Enfamil and supported by money from Tommee Tippee and Dr. Brown’s.

Who’s interests do you think it would represent?

It doesn’t take a rocket scientist to figure out that the organization has little to do with breastfeeding, less to do with consumers and everything to do with the sponsors promoting their own products.

Now consider Australia’s Maternity Consumer Network. It is sponsored by MyMidwives and Australian Doula College with money from a wipes manufacturer and the Mum Collective.

Whose interests do you think it represents?

Let me help you out with images from their websites:

My Midwives, motto “Midwifery Continuity of Care for Every Woman”:

Australian Doula College:

The Mum Collective, “Connecting brands with our community of influencers …”:

Do you see anything here about consumers? Me, neither!

I see a midwifery organization, a doula organization and a public relations organization that wants access to new mothers.

I see astro-turfing.

According to Merriam Webster, astro-turfing is:

organized activity that is intended to create a false impression of a widespread, spontaneously arising, grassroots movement in support of or in opposition to something (such as a political policy) but that is in reality initiated and controlled by a concealed group or organization (such as a corporation).

The folks at MCN, like any other industry representatives, are free to create an organization that pretends to represent consumers while actually representing themselves.

Hopefully, journalists will keep the MCN’s industry affiliations in mind in future articles involving them or pitched by them. If they want to hear from maternity consumers battling birth trauma, they should turn to the Australasian Birth Trauma Association (ABTA). ABTA was started by consumers, serves consumers and has a homepage that isn’t decorated with plugs for providers and industry.

That’s what a real consumer organization looks like.

A new paper in Sociological Forum, Making Milk and Money: Contemporary Mothers’ Orientations to Breastfeeding and Work, is helping me clarify my thoughts about breastfeeding. Although typically presented as a medical issue, breastfeeding mandates are actually a philosophical issue.

The author explores the different philosophies through the medium of women’s paid employment. She starts by noting that, just as expectations around women and paid employment have changed in industrialized nations, expectations around breastfeeding have also changed.

[C]ontemporary mothering expectations have increasingly expanded and intensified. One such expectation is that breast milk is (once again) considered the best source of infant nutrition; thus, “good” mothers breastfeed their babies. Indeed, the “breast is best” public health mantra has become ubiquitous…

Contrary to the claims of lactivists — who assume good motherhood means the same thing in every time, place and culture — this reflects a reframing of good motherhood in our culture. Not surprisingly, there are women resisting the dominant cultural model.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]There are two partners in the breastfeeding dyad and BOTH have needs.[/perfectpullquote]

The dominant model in contemporary industrialized societies is maternalist. This is the model promoted by La Leche League.

This model celebrates women’s ability to nourish, nurture, and bond with their child, and reclaims breastfeeding as part of women’s embodied and intuitive knowledge about reproduction… The maternalist perspective also has connections to “attachment” parenting and “natural” mothering, emphasizing children’s need to develop a safe and secure base through extensive physical and emotional connection with a primary caregiver—typically a mother.

Maternalist philosophy is a philosophy of obligation. Mothers who believe it are sure that women “owe” breastfeeding to their babies.

A subset of the maternalist philosophy is medicalized:

The medical model prioritizes the product of breast milk over the relational process of breastfeeding. From this perspective, as long as women produce milk for their infants, their physical presence is not necessary.

This is not a new philosophy. It undergirds the practice of wetnursing, a practice that has existed for millennia.

This both emerged from and perpetuates the paradigm of “scientific motherhood,” whereby women rely on “expert guidance” for childrearing. While expert guidance in the 1930s strongly promoted formula as the safest, most modern food, later professional opinions consistently emphasized breast milk. In the twenty-first century, major health organizations recognize breastfeeding as optimal for infant nutrition. If the primary rationale for breastfeeding is infant health, then it does not matter how breast milk is produced or consumed as long as women follow expert recommendations.

There are a number of ironies here. First is the irony that lactivists simultaneously demonize the doctors of the 1930’s who “wrongly” promoted formula, but are completely credulous regarding doctors of the 2010’s who promote breastfeeding. In my view, the present day promotion of breastfeeding as “best” is every bit as misguided as the 1930’s promotion of formula as best. There is no one-size-fits-all feeding recommendation. Recommendations should be tailored to the individual infant’s needs and circumstances.

The second irony is that the contemporary promotion of breastfeeding as the natural obligation of all mothers ignores the fact that there was ALWAYS a significant portion of women who opted out of breastfeeding, farming out their babies (often literally) to other women.

My philosophy of breastfeeding, in contrast, is holistic — encompassing the mother’s needs and desires as well as her obligations.

…[A] more recent public discourse on infant feeding has been ushered in with the “fed is best” campaign. While most directly connected to the nonprofit foundation of the same name, this has turned into a new mantra to critique the cultural hegemony of exclusive breastfeeding at all costs, and the perceived vilification of mothers who use any formula. This emerging discourse appears more women-centric, recognizing that the push for exclusive breastfeeding may create unrealistic and harmful expectations.

Fed is best, explicitly recognizes that their are two partners in the breastfeeding dyad and both have needs and desires that must be addressed:

The baby needs to be fed. Even those most hostile to me and to the Fed Is Best Foundation recognize that, sneering that “fed is minimal.” But that’s the point! If you aren’t adequately nourishing a baby by breastfeeding, you haven’t even met its most fundamental need. Fully fed with formula is BETTER than underfed with breastmilk.

The baby needs physical contact with the primary parent, but breastfeeding is not a necessary part of that contact. Throughout the millennia, those who hired, forced or enslaved a wetnurse were never worried that the baby would bond to the wetnurse instead of the mother.

The mother has needs, too. In contrast to the maternalist/medicalized philosophy of breastfeeding that explicitly ignores the mother’s needs, the holistic philosophy respects them. My mantra — her baby, her body, her breasts, her choice — reflects that.

As the author of the paper notes:

Women’s orientations to breastfeeding are shaped by differing, historically situated cultural models and discourses. While women do hold themselves accountable to these, there is no universal set of expectations because of the coexistence of different ideas about infant feeding and mothering.

This is a critical point. Like the founders of the Fed Is Best Foundation, I don’t “hate” breastfeeding. Why would I or they hate it when we nourished our children through breastfeeding and enjoyed it?

And I don’t hate the maternalism/medicalization philosophy of obligation, the belief that the mother’s needs pale into insignificance next to her “obligation” to breastfeed her baby. To an extent, I shared it. The term “attachment parenting” didn’t exist when my children were small, but that’s the kind of parenting I practiced because I thought it was best for my children and for me.

My professional philosophy, in contrast, is holistic. Other women have different needs — including the need to earn money, the need to have a profession, and the need for time away from children — and those needs should be respected.

But the fundamental difference between the maternalism/medicalization philosophy and my philosophy is this: I recognize that I am not the model to which all other women should aspire. My ego is not threatened if you feed your babies a different way than I fed mine. Unfortunately, lactivists appear to feel otherwise.