It is perhaps the ultimate irony.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””] There has never been a randomized controlled trial that shows attachment parenting doesn’t cause autism![/perfectpullquote]

Advocates of attachment parenting, many of whom reject vaccination because of fear of autism, have failed to recognize that it is attachment parenting itself that causes autism.

Consider the ever growing body of evidence:

1. Both autism and attachment parenting have increased dramatically in the past two decades. The concept of attachment parenting is credited to Dr. William Sears, who first mentioned it in his book in 1988. Studies show that in the VERY SAME YEAR, the incidence of autism began to rise dramatically. (Environ. Sci. Technol., 2010, 44 (6), pp 2112–2118).

2. Regardless of who practices attachment parenting or how they define it, no one can deny that the practice of attachment parenting ALWAYS precedes the diagnosis. There are no known cases in which attachment parenting practices began after autism was diagnosed.

3. The purported mechanism is thought to be the sensory deprivation caused by baby wearing and extended breastfeeding. During the critical early months and years, when babies should be learning about the world and making millions of neuronal connections, babies exposed to AP are deprived of contact with the outside world (many are constantly carried in a position where they can see nothing but the surface of the mother’s clothing) and their exposure to other individuals such as fathers, grandparents and childcare workers is severely limited.

4. No one has EVER shown that attachment parenting does not cause autism.

5. Even those who strongly reject the notion that attachment parenting causes autism acknowledge that there are MANY children raised with attachment parenting who are subsequently diagnosed with autism.

6. Many of those who deny a link between attachment parenting and autism stand to lose money if attachment parenting is shown to be harmful. Authors, lactation consultants, and sling manufacturers, among others, have a strong economic motivation for discouraging investigation of this link.

It is time to launch a comprehensive investigation of the harmful side effects of attachment parenting in general, and the relationship between attachment parenting and autism in particular. It’s hardly coincidental that the same people who make money from attachment parenting have NEVER bothered to study these harmful effects. They insist that attachment parenting is beneficial, but there is no way they can know for sure.

****

Those who have read this far have probably figured out that this is a satire. I’m satirizing the “thinking” of anti-vaccine parents on the purported relationship between vaccines and autism. The purpose of the satire is to demonstrate that what seems to anti-vaxxers to be irrefutable “reasoning” is nothing more than nonsense and logical fallacies.

The above list highlights the major rhetorical gambits of anti-vaxxers. Number 1 is the claim that because both vaccination and autism have risen in recent decades, vaccines must cause autism. That claim is foolish as can be seen when the same observation is made about attachment parenting and autism. Just because the incidence of two phenomena rise at the same time does not mean that one caused the other. And that doesn’t even take into account the fact that rates of vaccination have actually been FALLING while rates of autism have been rising.

Number 2 is the temporal connection. Early childhood vaccination precedes the observation of autistic symptoms, but a lot of things precede the observation of autistic symptoms. That’s because those symptoms typically do not appear until the early toddler years and anything that takes place during infancy (like attachment parenting practices) will precede the observation of symptoms.

Number 3 invokes a spurious mechanism of action. It is certainly plausible, but no evidence is presented that it actually occurs. Anti-vaxxers play the same tricks with claims about the deleterious effects of “toxins” in vaccines.

Number 4 is the “argument from ignorance.” The argument from ignorance dares the opponent to prove a negative and when a negative cannot be proven (since that is a logical impossibility in most cases), the conclusion is proclaimed that this “shows” that vaccines cause autism.

Number 5 is the “fallacy of the lonely fact.” Since some children have developed autism after their parents practiced attachment parenting, the conclusion is drawn that large numbers of children will develop autism after their parents practice attachment parenting.

Number 6 is the conspiracy theory that undergirds almost every attempt to defend anti-vax. But when the same “reasoning” is applied to attachment parenting, it is easy to see that the conspiracy theory does not have much explanatory power. There is ALWAYS someone who stands to benefit from any recommendation or practice. That does not mean that those who benefit are actively hiding information on harms and risks from everyone else.

The concluding paragraph is the seemingly innocuous call for “more research.” But we cannot and should not waste time “researching” connections that have no basis in science. If we did, we could spend a lot of time “researching” whether the moon is made of green cheese or whether clouds are made of marshmallows. The call for “more research” is just away to add gravitas to what are often ridiculous claims. We do not need to “research” every wacky idea that anti-vaxxers devise and our refusal to “research” those ideas without basis in science or logic is not a sign that someone is hiding something.

The key point is that what passes for “reasoning” among anti-vaxxers is not reasoning at all. It is nothing more than wild accusations, logical fallacies and conspiracy theories. There is no more reason to take seriously the idea that vaccines cause autism than there is to take seriously the idea that attachment parenting causes autism.

Want to enrage a lactivist? Turn their tactics against them.

Lactivists insisting that corporations profit from formula? Point out that lactation professionals make 100% of their income from promoting breastfeeding.

Lactivists boasting breastfeeding saves lives? Ask them why they can’t show term babies whose lives have been saved.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]This is just the beginning![/pullquote]

Lactivists waxing rhapsodic over the purported benefits of breastfeeding? Mention that exclusive breastfeeding has become the LEADING risk factor for newborn re-hospitalization.

All are variants of culture jamming, the practice of forcing people to question the status quo, in this case the unreflective and unscientific insistence that breast is best. Lactivists get so mad when they are culture jammed!

In order to turn their tactics against them, it helps to understand exactly how those tactics work. The paper Embodied Online Activism: Breastfeeding Activism (Lactivism) on Facebook is very helpful in that regard.

The author starts with history of the movement:

Grass-roots breastfeeding support used to be understood and studied as face-to-face support groups based on formal and informal peer support. Over the last ten years, with a growing importance of mediatised sociability and the creation of ‘digital mundane’ practices of daily interactions and constant connectivity, a new form of grass-roots mobilisation has emerged.

She reports on her study of lactivist Facebook groups:

We share pictures of ourselves breastfeeding our children (‘brelfies’), experiencing the pleasure and navigating the exposure this kind of sharing can bring, including anger and fear of charges of ‘indecency’. We can also be ‘vicariously traumatised’ by the experiences of others: death of a fellow member’s child, reports of neglect, abuse, illness or stories of birth trauma. The complexities of ‘translations’ of self into social media spaces are also premised on presence – being ‘on’ for the night feeds, tapping away to fellow night-feeders with one hand, whilst nursing a child. Presence in a group is therefore experienced and performed on a personal, intimate level, but also ‘done’ in public ways.

The Fed Is Best Foundation support groups have copied lactivists. Women share pictures of their healthy breastfed, formula fed or tube fed babies. Group members are traumatized by the experiences of women whose babies have been harmed by breastfeeding. Women provide each other with support at any time of the day or night.

Facebook breastfeeding groups are primarily spaces of support, in which informational and instrumental support are inextricably linked with affirmation and emotional support parents receive. The ‘knowledge base’ on breastfeeding – research on human milk and lactation – is used to learn to live as a breastfeeding body and turned by group members into practical, actionable know-how. Biomedical knowledge on breastfeeding is also used by lactivist to justify and defend the practice, bolstered by technologically-facilitated knowledge dissemination, using pictorial content and mediated connectivity, which allows for breastfeeding knowledge to be circulated quickly and efficiently.

Fed Is Best support groups as well as groups created by me and other feeding safety advocates offer support in which scientific evidence is inextricably linked with affirmation and emotional support.

Lactivists love memes:

One example of this is the stomach size meme, which ranks amongst the most frequently shared lactivist images, using comparisons with fruit, marbles, or sweets to visualise the size of a newborn infant’s stomach. Its widespread use in online forms of breastfeeding activism – in groups, but also by pages and blogs – attests to a synergy between content (easy to read, pictorial information) and its digital format (easy to duplicate, copy, forward, and Typically posted as a comment or relayed in a ‘PM’ (private message), the swiftness of reply and the ease of re-posting are crucial, if the information is to reach a person pressurised to use formula to supplement… As digital artefacts ‘memes’ are also manipulable – easy to adapt, edit and (re)produce in different linguistic versions, another aspect of importance across different contexts of lactivism.

Sadly, this lactivist meme is a lie based on a paper from 1921. Copious, contemporary scientific evidence shows that infant stomach capacity is far larger. Feeding safety advocates counter it with memes of our own.

I use memes daily for the same reason that lactivists use them: they’re easy to understand, share and adapt to specific situations. My memes have the added advantage of accurately representing the scientific literature.

But the heart of lactivist activism is “electronic contention.”

For example, alterations to ‘walls’ have been made easier through the ‘report a correction’ feature. Using this function lactivists blocked from commenting and engaging in debate on a ‘bingo’ wall repeatedly corrected the erroneous claims made in its public posts.

Similarly, the function of ‘rating’ business pages facilitates ‘negrating’, or negative rating of pages representing businesses deemed to be discriminating against breastfeeding women or expressing negative views on breastfeeding. A coordinated mass action, negrating involves posting negative ratings and reviews on the offender’s wall and bringing its rating down using Facebook’s star system. Negrating aims to negatively impact the reputation of an organisation (reputational damage).

Both of these direct and disruptive forms of action are perceived from within the movement as ‘defence’ and as an ‘adjustment’ or ‘corrective’ measure, but may be interpreted by the affected entities (and their followers) as a (coordinated) ‘attack’…

Feeding safety advocates are able to react to lactivist attacks by using their tactics against them: reporting comments, negrating and descending en masse on “offending” Facebook pages.

The ways in which such individual interventions are then multiplied through specific technological means by lactivists whose mutual allegiance grows out of a sense of commonality predicated on engagement in an embodied practice of breastfeeding, is equally important for understanding the role of embodiment in online activism. Actions which use social media technologies in similar ways, like metadata tagging to raise awareness of an issue (hashtags) or documentation of transgressions and harassment (hollabacks), are not uniquely lactivist and have been used across social media.

That’s why feeding safety advocates use them, too.

The Fed Is Best Foundation has begun copying lactivists’ offline actions, too. They purchased their first billboard to alert women to the dangers of insufficient breastmilk and offer them an opportunity to connect with the organization. The billboard was purchased with money from — among others — parents whose babies have been harmed. Lactivists have responded with shock and anger. How dare feeding safety advocates use the exact same tactics that lactivists have mobilized against them?

I’ve got news for lactivists: this is just the beginning!

Feeding safety advocates are watching lactivists and learning from them. Most importantly we have realized that if a lactivist tactic is effective against us, it will be equally effective when deployed against lactivists.

There’s nothing wrong with breastfeeding. There’s a tremendous amount wrong with the lactation profession.

How can that be? Aren’t lactation professionals simply promoting breastfeeding?

That was probably how it started out, but they quickly became obsessed with exclusivity; that fetish is harming babies and mothers.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There’s one infant feeding goal that eclipses all others: the baby’s goal to be fully fed.[/pullquote]

I can’t tell you when the obsession started; it certainly didn’t exist when my children were born in the late 1980’s and early 1990’s. But I can tell you when it became codified: 1996 with the publication of Diane Weissinger’s seminal paper Watch Your Language.

Weissinger drew the battle lines:

When we … say that breastfeeding is the best possible way to feed babies because it provides their ideal food, perfectly balanced for optimal infant nutrition, the logical response is, “So what?” Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy and thus safety and adequacy-of artificial feeding…

That isn’t quite accurate — breastfeeding is a great, but not the best possible, way to feed babies — but it does highlight a central insight: lactation professionals recognized that when they tell the truth about breastfeeding, many women will choose not to do it.

Therefore, Weissinger encouraged lactation professionals to exaggerate the benefits of breastfeeding and massively exaggerate the “harms” from formula feeding. Her goal — and it became the goal of the profession as a whole — was to give women no choice but to breastfeed.

Why?

Weissinger was startlingly honest:

We cannot expect to create a breastfeeding culture if we do not insist on a breastfeeding model of health in both our language and our literature.

And:

All of us within the profession want breastfeeding to be our biological reference point. We want it to be the cultural norm; we want human milk to be made available to all human babies, regardless of other circumstances.

Do you see anything there about what’s good for babies and mothers? I don’t. I see an effort to create full employment for lactation professionals.

Lactation professionals did more than merely exaggerate the benefits of breastfeeding and concoct “risks” of formula feeding; they became obsessed with exclusivity.

Prior to the 1990’s the thinking went that if some breastfeeding is good, more breastfeeding is probably better. But that practical position hardened into the fabricated claim that “even one bottle of formula” can harm an infant.

Where was the evidence for that position? There wasn’t any. There wasn’t even a theory; the claims about the microbiome came a generation later.

Indeed, to the extent that research had investigated the issue, it was difficult to find any dose-response relationship for breastfeeding. Some minimum amount of breastfeeding (two months, for example) appeared to convey many of the SAME benefits as longer duration of breastfeeding.

No matter. Exclusivity has been fetishized and that obsession is responsible for the harms of breastfeeding promotion we see to day.

Exclusive breastfeeding is the LEADING risk factor for newborn re-hospitalization. It results in approximately 40,000 preventable newborn hospitalizations a year at a cost of hundreds of millions of dollars. Breastfeeding isn’t the problem; exclusive breastfeeding is.

How can that be? Breastfeeding, like any natural process, has a significant failure rate. Up to 15% of mothers may be unable to produce enough breastmilk to fully nourish a baby, at least in the days immediately following birth. That might sound high until you consider that fully 20% of established pregnancies end in miscarriage. Nature doesn’t do perfection; it does “good enough.”

Imagine how different the experience of breastfeeding could be if lactation professionals didn’t fetishize exclusivity: the benefits — medical, psychological and economic — could be enormous.

No baby would be forced to experience agonizing hunger; any mother who felt her baby needed formula could offer it.

Once home, women could both reduce pressure on themselves and get more sleep by allowing partners and family to feed the baby one or more bottles per day.

Women could more easily return to jobs and careers knowing that they don’t have to pump every two or three hours because the baby sitter or daycare provider can give formula if there is not enough stored breastmilk.

It’s not breastfeeding that is causing dehydration, starvation, maternal exhaustion, maternal guilt and shame; it’s the fetish for exclusive breastfeeding.

But wait! Aren’t lactation professionals merely helping women meet their breastfeeding goals?

Prof. Amy Brown asks What Do Women Lose if They Are Prevented From Meeting Their Breastfeeding Goals?

Many women stop breastfeeding before they are ready, often leading to feelings of anxiety, guilt, and anger. Critics of breastfeeding promotion blame breastfeeding advocates for this impact, claiming that if the focus were merely on feeding the baby, with all methods equally valued and supported, maternal mental health would be protected. Established health impacts of infant feeding aside, this argument fails to account for the importance of maternal breastfeeding goals …

But who made exclusivity a goal? It wasn’t mothers. Prelacteal supplementation is common in cultures around the world. It is lactation professionals who fetishize exclusivity.

But that reality doesn’t stop Brown:

The purpose of this article is to highlight the importance of recognizing and valuing women’s individual breastfeeding goals, and not dismissing or invalidating their experience if they do not meet these by telling them that they do not matter.

Brown seems to have forgotten the most critical goal of all, the one that eclipses ALL other goals: the baby’s goal to be fully fed.

The bottom line is that the obsession with breastfeeding exclusivity is a fetish of lactation professionals. There is very little if any scientific support for it; it is harmful to babies and mothers; and the only ones who appear to benefit from it are lactation professionals themselves.

The term birthrape didn’t work out so well for the natural childbirth industry.

It was in vogue for several years, but generated not the outrage at obstetricians that midwives and doulas were hoping for, but rather revulsion at their appropriation of the suffering of rape victims to publicize their cause.

The new term is obstetric violence.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Campaigns against obstetric violence aren’t about protecting women; they’re about promoting midwives.[/pullquote]

But there’s a dirty little secret at the heart of campaigns against obstetric violence: they rarely mention midwives, a major group of perpetrators. How do I know that midwives are a significant source of obstetric violence? Because that’s what the scientific literature shows.

A new study in The Lancet, How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys, raises the alarm:

We prospectively recruited women aged at least 15 years in twelve health facilities (three per country) in Ghana, Guinea, Myanmar, and Nigeria between Sept 19, 2016, and Jan 18, 2018. Continuous observations of labour and childbirth were done from admission up to 2 h post partum. Surveys were administered by interviewers in the community to women up to 8 weeks post partum. Labour observations were not done in Myanmar. Data were collected on sociodemographics, obstetric history, and experiences of mistreatment.

What did they find?

2016 labour observations and 2672 surveys were done. 838 (41·6%) of 2016 observed women and 945 (35·4%) of 2672 surveyed women experienced physical or verbal abuse, or stigma or discrimination. Physical and verbal abuse peaked 30 min before birth until 15 min after birth (observation). Many women did not consent for episiotomy (observation: 190 [75·1%] of 253; survey: 295 [56·1%] of 526) or caesarean section (observation: 35 [13·4%] of 261; survey: 52 [10·8%] of 483), despite receiving these procedures. 133 (5·0%) of 2672 women or their babies were detained in the facility because they were unable to pay the bill (survey). Younger age (15–19 years) and lack of education were the primary determinants of mistreatment (survey). For example, younger women with no education (odds ratio [OR] 3·6, 95% CI 1·6–8·0) and younger women with some education (OR 1·6, 1·1–2·3) were more likely to experience verbal abuse, compared with older women (≥30 years), adjusting for marital status and parity.

The study itself has generated mainstream press and has been highlighted by midwives and their advocates. But here’s the kicker: there are very few obstetricians in these facilities; much of the violence was committed by midwives.

If those complaining loudest about obstetric violence actually cared about women, they’d acknowledge that midwives are perpetrators. Perhaps some of them do, but I haven’t seen it yet. That doesn’t surprise me because complaints about obstetric violence aren’t about improving birth for women; they’re about demonizing obstetricians, midwives’ chief economic competitors.

Ironically, midwives have institutionalized perhaps the largest category of obstetric violence: campaigns for “normal birth.” Denying women epidurals, trying to talk them out of them, delaying them or failing to call for the anesthesiologists who can perform them is emblematic of obstetric violence. There is not much that is more brutalizing in a healthcare setting than deny relief for excruciating pain.

That’s merely one aspect of abusive campaigns for “normal birth.”

Consider activist Amie Newman’s definition of obstetric violence:

It is an umbrella term that includes disrespectful attitudes, coercion, bullying, and discrimination from care providers, lack of consent for examinations or treatment, forced procedures like C-section by court order, and also physical abuse.

It’s hard to imagine anything more disrespectful than telling a woman how she ought to give birth and ignoring what she might want (pain relief, interventions, maternal request C-section), yet this is precisely what campaigns for normal birth do. By campaigning on behalf of a process instead of for patients themselves, proponents of unmedicated vaginal birth are explicitly ignoring the needs and wishes of those patients.

A good rule of thumb for respectful care is: “Nothing about me without me.”

Declaring that unmedicated vaginal birth is an institutionally supported goal instead of one choice among many possible choices, midwifery organizations are most definitely making policy and determining practice WITHOUT the input of women.

When will campaigns against obstetric violence take midwives to task for their role in perpetuating it? Not any time soon. Why? Because campaigns about obstetric violence aren’t about protecting women; they’re about promoting midwives.

A new paper confirms what we have known for several years: the Baby Friendly Hospital Initiative is a failure on its own terms.

I’m not talking about the fact that it harms babies with its dubious “achievement” of making exclusive breastfeeding the leading risk factor for newborn re-hospitalization leading to tens of thousands of re-hospitalizations per year at a cost of hundreds of millions of dollars.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Instead of putting lactation professionals in charge of doctors and nurses; put doctors and nurses in charge of lactation professionals.[/pullquote]

I’m not talking about the fact that its insistence on forcing 24 hour mother-infant rooming in has led to a small epidemic of newborns suffocating in their mother’s hospital beds or sustaining skull fractures from falling out of them.

And I’m not talking about the soul searing guilt that as many as 15% of mothers experience when they are biologically incapable of producing enough breastmilk to fully nourish an infant, especially in the early days after birth.

No, I’m talking about the fact that the Baby Friendly Hospital Initiative (BFHI) appears to have NO IMPACT on breastfeeding rates after hospital discharge.

A new paper, Outcomes from the Centers for Disease Control and Prevention 2018 Breastfeeding Report Card: Public Policy Implications, looked at breastfeeding data for all the nearly 4 million infants born in the US in 2015.

Breastfeeding outcome data from the 2018 Centers for Disease Control (CDC) Breastfeeding Report Card were used as a basis for determining outcomes from the corresponding 2015 birth cohort. Linear regression models were used to determine the strength of association of breastfeeding initiation and Baby-Friendly hospital penetrance and attainment of postdischarge breastfeeding rates. All hospital births from all 50 states, 3 territories, and the District of Columbia were included in the study.

They failed to find ANY ASSOCIATION (let alone causation) between the BFHI program and breastfeeding continuation rates.

Baby-Friendly designation did not demonstrate a significant association with any postdischarge breastfeeding outcome. There was no association between Baby-Friendly designation and breastfeeding initiation rates.

The results are starkly presented in two sets of graphs.

Any Breastfeeding at 6 and 12 months:

Exclusive Breastfeeding at 3 and 6 months:

The left side of each set shows a strong correlation — not surprisingly — between breastfeeding initiation rates and breastfeeding continuation rates. As breastfeeding initiation rates rise, breastfeeding rates at 6 and 12 months and exclusive breastfeeding rates at 3 and 6 months rise. The correlation is not surprising since only those women who start breastfeeding can continue breastfeeding.

The right side of each set shows NO correlation between births at BFHI facilities and breastfeeding continuation rates. Those who gave birth at BFHI facilities are NOT more likely to breastfeed at 6 and 12 months (or exclusively breastfeed at 3 and 6 months) than those who gave birth at non-BFHI facilities. The increasing adoption of BFHI certification has had NO IMPACT on breastfeeding rates.

My take away:

Instead of putting lactation professionals in charge of doctors and nurses in an effort to increase breastfeeding rates, we should be putting doctors and nurses in charge of lactation professionals.

The findings of this paper are neither new nor unexpected.

By the end of 2016, it had become clear that the BFHI failed to increase breastfeeding rates. The paper Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms noted:

…[O]nly individual-level interventions demonstrated effectiveness at improving breastfeeding, whereas system-level interventions, including the World Health Organization’s Baby-Friendly Hospital Initiative (BFHI), did not.

By November 2018, enough data had accumulated for the editor of the premier breastfeeding journal to call for a review of the Ten Steps on which the BFHI is based. He noted that A Critical Review of the Baby-Friendly Hospital Initiative Is in the Works.

The author’s use of scare quotes is particularly telling:

One cannot argue with the recent “success” of the Baby-Friendly Hospital Initiative (BFHI) that was established in 1992 in response to a call to action for support of breastfeeding by the 45th World Health Assembly…

In 2011, in only two states was there >20% BFHI penetration. In 20 states there were no Baby-Friendly facilities. Seven years later, in 2018, 40% of the birthing facilities in 12 states were certified as Baby-Friendly. Most striking, >1 million births (roughly 25%) of the annual US birth cohort were taking place in such facilities…

But there was no evidence that it was having any impact on breastfeeding rates. He concludes:

The measure of success of any initiative should not be the number of certified institutions per se but the actual breastfeeding rates that will meet our healthy people objectives.

The Baby Friendly Hospital Initiative chooses to incentivize hospitals, nurses and lactation consultants on certification rates and exclusive breastfeeding rates at discharge. There was NEVER any data that showed that either was correlated with breastfeeding continuation rates. Now there’s increasing evidence that they are definitively NOT correlated with breastfeeding continuation rates.

The BFHI is actually HARMING babies and mothers.

As the authors of the new paper 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.

In addition, there has been increasing recognition of adverse perceptions of Baby-Friendly designation based on reports of the experiences of some mothers in Baby-Friendly designated hospitals. This is reflected in the new WHO Baby-Friendly Guideline statement on the need to respect maternal autonomy and avoid judgmental attitudes which could infringe on the mother’s dignity. The Breastfeeding Report Card outcomes also support the results of the recent US Preventive Services Task Force report, which demonstrated that Baby-Friendly designation was not a consistently effective intervention and that individual approaches were more successful.

The authors conclude:

Baby-Friendly designation penetrance did not demonstrate any positive postdischarge breastfeeding association.

In other words, putting a private organization of breastfeeding professionals in charge of breastfeeding in hospitals has been a terrible mistake and a failure on its own terms. If we want to increase breastfeeding rates and reduce breastfeeding complications, we should put hospitals, doctors and nurses in charge of lactation professionals.

The BFHI has become little more than a full employment program of, by and for lactation professionals. No doubt they are already penning their Letters to the Editor to defend the increasingly indefensible Baby Friendly Hospital Initiative. Let the excuses begin!

In the summer of 2000 I was diagnosed with a brain tumor.

I had developed double vision because a benign tumor, a meningioma, was pressing on the nerve that controlled the movement of one of my eyes. The tumor was small, but located deep in my brain. That meant that surgery to remove it would likely lead to significant nerve damage.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Under the guise of what’s best for women, midwives & lactation professionals recommend what’s best for themselves.[/pullquote]

Surgery was, up through the 1990’s, the only treatment. However, as a physician I had access to those who knew about the latest options. A dear friend, a neuro-radiologist, told me about stereotactic (“gamma knife”) radiosurgery, which is not surgery at all, but a one day course of radiation to kill the tumor.

I consulted a neurosurgeon, widely reputed to be one of the best in the US, to find out what he recommended. He recommended surgery.

I asked him:

Which treatment had the highest cure rate? He told me that surgery had a cure rate of 85% and radiation had a cure rate of 95%.

Which treatment had the highest complication rate? He told me that surgery would likely lead to loss of sensation on the left side of my face and deafness in my left ear. Radiation had no complications beyond local irritation.

If radiation treatment failed, would that make subsequent surgery more risky? He told me that it would have no effect.

So I asked him why he was recommending surgery if radiation had a higher cure rate and a lower complication rate. To his credit, he replied honestly:

“I don’t do the gamma knife.”

In other words, under the guise of recommending what was best for me, the surgeon recommended what was best for HIM. His financial and non-financial conflicts of interest led him to recommend the application of his personal skills.

But here’s the key point: I don’t doubt that he believed surgery was best.

Because of his personal experience, he believed implicitly in his surgical skills. Because of his lack of experience with the new form of radiation treatment he distrusted it. Because too much of medical practice is doing what you have been taught to do — in his case surgery — he recommended surgery.

That’s also the ethical problem at the heart of contemporary midwifery and lactivism. Under the guise of what’s best for women, they recommend what’s best for themselves.

And here’s the key point: I don’t doubt that they believe it.

Because of their personal experience, midwives and lactation consultants believe implicitly in their own skills. Because of lack of broader experience with complications, they are sure they don’t exist or are “variations of normal.” Because too much of midwifery and lactation medicine is recommending what they’ve been taught to do, they always recommend themselves and their limited skills.

Midwives like Sheena Byrom and Hannah Dahlen consistently recommend the application of midwifery to just about every situation. Byrom and Dahlen consistently demonize anything they can’t bill for — such as epidural anesthesia or C-section. If they can’t do it, they fervently believe, you don’t need it.

They are blind to the fact that their financial and non-financial conflicts of interest cause them to recommend what is best for midwives, NOT what is best for mothers and babies.

Lactation professionals like Amy Brown, Jack Newman or Natalie Shenker relentlessly recommend breastfeeding and greater financial support for lactation professionals. It doesn’t matter what the situation might be, the answer is ALWAYS more lactation support and more breastfeeding and pumping. They consistently demonize formula because they can’t bill for it and it undercuts their own economic wellbeing. As far as they’re concerned, if they can’t do it, you don’t need it.

They are blind to the fact that their financial and non-financial conflicts of interest cause them to recommend what is best for them, NOT what is best for mothers and babies.

Most women don’t have the luxury I had, not merely the ability to consult multiple providers, but the professional contacts to know whom to call. Ultimately, I chose to have the radiation treatment, a 9 hour marathon in a machine like an MRI, involved having a metal frame anchored into my skull. The results — as I had been counseled — were not immediate since it took time for the tumor to shrink and die. It was three months before I noticed any improvement and six months before the double vision completely resolved.

On the other hand, there was no surgical recovery. No drilling into my skull. No bleeding or infection. No hearing loss or loss of feeling in my face.

I do not begrudge the neurosurgeon for his recommendation to have a major surgical procedure that I didn’t need and could have harmed me. He was honest and I was aware that surgeons tend to recommend surgery even when there are other (sometime better) treatment options available. They know their own skills and trust them. They don’t trust technologies that are new and with which they are unfamiliar.

But a better surgeon, with greater awareness of his own financial and non-financial conflicts of interest, would have made it his business be thoroughly familiar with treatment options beyond those he could offer. He would have recommended the radiation treatment — or counseled me about it at the very least — since that was an option I deserved to have. It was also the option that was best for me, far better than what he could offer.

Ethical midwives, with greater awareness of their own financial and non-financial conflicts of interest, would counsel women about all options and not demonize the ones they can’t offer. I don’t doubt that they believe with every fiber of their being that midwifery care is almost always best. They can’t see the truth that just because it is best for them, doesn’t mean it is best for babies and mothers.

Ethical lactation professionals, confronted with the fact that they have single handedly made exclusive breastfeeding the leading cause of newborn re-hospitalization, would offer formula to any woman who wants it, not demonize formula and certainly not insist that what women need is more of the “support” that harmed their babies. I don’t doubt that they believe with every fiber of their being that breastfeeding is almost always best. They can’t see the truth that just because it is best for them, doesn’t mean that it is best for babies and mothers.

It was my brain tumor, in my head, and I deserved to know all the options for treatment so I could make MY choice.

When it comes to birth and breastfeeding: her body, her baby, HER choice … free from pressure by those who stand to benefit from offering only what they can do.

It’s truly amazing the lengths to which lactation professionals will go to avoid having to address the elephant in the room. They’ll even invite me to lunch!

What’s the elephant?

Exclusive breastfeeding has become the LEADING risk factor for newborn re-hospitalization.
As many as 1 in 71 exclusively breastfed babies will be re-hospitalized.
That means approximately 40,000 PREVENTABLE re-hospitalizations per year.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Why wait until we’re in the same city, Leah? I’m happy to meet you on Facebook Live any time, including today![/pullquote]

No professional health or lactivist organization — not La Leche League, not the World Health Organization, not the American Academy of Pediatrics — denies it.

Indeed the problem has become so acute that at the forthcoming AAP Annual Meeting, they are devoting a “Controversies in Pediatrics” session to the Baby Friendly Hospital Initiative. You don’t do that if you think the program is safe and successful.

That’s the background against which I took issue with the flagrantly false claims of Yashed LC, Leah Drexler, who thought she was criticizing the Fed Is Best Foundation, but was actually illustrating her own appalling lack of knowledge on the critical topic of infant dehydration/starvation.

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 and it’s terrifying. I’ve caught a few with senseless old nurses who are just like “he’s so sleepy”…YEAH HE’S PROBABLY FORMING KERNITERUS [sic] GENIUS.

For some inexplicable reason, Drexler appears to think there is no middle ground between getting adequate calories and getting none. A baby will cry when he is hungry; if breastmilk is insufficient, he will continue to cry after eating and that crying will be powered by the calories that he did ingest.

Drexler’s nonsensical claim is hilarious, right? Not exactly. Fully 90% of cases of kernicterus (jaundice induced brain damage) occur in breastfed babies. The arrogant ignorance of lactation professionals like Drexler that is harming newborns each and every day.

I commented:

Why is Yashed LC trying to normalize infant starvation? Why is she gaslighting women who speak out about the harm to their babies and themselves?

Exclusive breastfeeding has become the LEADING risk factor for newborn hospital readmission. There are tens of thousands of preventable newborn hospitalizations per year at a cost of hundreds of millions of dollars.

What is Yashed LC doing about it besides pretending it isn’t happening? …

Drexler had no answer to that nor does she wish to discuss it. But she needs to fool her followers by changing the subject.

She posted a long — and entirely irrelevant — screed to the members of her private group, ending with this:

Lastly, because she is wholly incapable of matching the strength and receipts [sic] of the trees she keeps barking up: tell her to meet me and KSA for lunch. I hear she has no capacity to have a reasonable conversation in real life but Kimberly Seals Allers and I would love to give her the opportunity to prove everyone Wrong! Never too late to change. I mean … she could be the OB who discovers how to cure breast malfunction! …

Oh, and because I know you’re still in here, the answer is in my and Kimberly Seals Allers we do these things in person. Full legitimacy. You can email me at … Make sure you copy KSA, since you are suddenly so ready to talk.

I responded that I’m not going to email her (just like I didn’t email Maureen Minchin) because I don’t trust either of them to accurately report back to their followers. Drexler is already insisting that any discussion take place NEXT YEAR, apparently hoping her followers will forget that I already bested her.

Why wait until we’re in the same city, Leah? I’m happy to meet you on Facebook Live any time, including today!

Surely you want to set the record straight and explain why you ignored my substantive claims, right?

Or maybe you just want to hide. We’ll see.

MyMilk Labs launches Mylee, a small sensor that analyzes breast milk at home is the title of a recent piece on TechCrunch:

Parents often worry about if their babies are getting enough nutrition or if they are producing enough milk. MyMilk Labs wants to give nursing mothers more information with Mylee, a sensor that scans a few drops of breast milk to get information about its composition and connects to a mobile app…

The Mylee launched at Disrupt with a pre-order price of $249 (its regular retail price is $349). Based in Israel, MyMilk Labs was founded in 2014 by Ravid Schecter and Sharon Haramati, who met while working on PhDs in neuroimmunology and neurobiology, respectively, at the Weizmann Institute of Science…

Breast milk changes in the first days and weeks after birth, progressing from colostrum to mature milk. Mylee scans the electrochemical properties of milk and then correlates that to data points based on MyMilk Labs’ research to calculate where the sample is on the continuum, then tells mothers if their milk is “delayed” or “advanced,” relative to the time that has passed since they gave birth.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It could work, but we need much more data to know if it does work.[/pullquote]

Does it work? Should anyone use it? The short answers: it could work; we need to see data about its sensitivity and specificity; and lactation professionals have philosophical objections to it.

It could work

I can’t find much technical information about the device, but the theory behind it is sound. Lactogenesis II is the process responsible for the progression of breast milk production from colostrum, through transitional milk to mature milk. There is a biomarker that can be used to track progress through the progression.

The Relation between Breast Milk Sodium to Potassium Ratio and Maternal Report of a Milk Supply Concern (2017) explains:

The ratio of breast milk sodium to potassium concentrations (breast milk Na:K) dramatically declines … as lactation progresses through colostral, transitional, and mature milk production stages; thus, decreasing breast milk Na:K is an objective biomarker of mammary gland progress toward copious mature milk production over the first week postpartum.

When they compared the breastmilk of women reporting low supply to that of women with adequate supply they found:

…[E]levated day 7 breast milk Na:K occurred in 42% of mothers with a day 7 milk supply concern, compared with 21% of mothers without a day 7 milk supply concern (unadjusted relative risk, 2.0; P = .008) (Table II). The unadjusted odds of elevated Na:K were 2.7 greater (95% CI, 1.3-5.9) with maternal report of milk supply concern (reference = no concern, P = .01) and further increased after adjustment for maternal ethnicity (3.4; 95% CI, 1.5-7.9; P = .003).

In other words, in contrast to lactivist beliefs, women who reported low supply did not “misperceive” the situation. Their breastmilk had an elevated ratio of sodium (Na) to potassium (K).

If concerns about milk supply among exclusively breastfeeding women were primarily owing to a lack of knowledge about the signs of abundant milk production, then the expected outcome would be no difference in breast milk Na:K as compared with exclusively breastfeeding women without milk supply concerns… Instead, the observed prevalence of elevated Na:K was 2-fold greater in the mothers with milk supply concerns (42% vs 21%)… This result challenges the belief that milk supply concern in the context of exclusive breastfeeding is primarily maternal misperception…

If the Mylee device analyzes the Na/K ratio and compares it to the expected ratio based on time since birth, the device could diagnose insufficient milk supply.

Does it actually work?

There’s no way to know without analyzing data from large numbers of women. Even if the device can successfully predict low milk supply, we’d need to determine its accuracy. What’s the false positive rate (indicating low supply even though supply is adequate)? What’s the false negative rate (indicating adequate supply even though supply is low)? Without that information — from a peer reviewed scientific paper — it is impossible to know if the Mylee device does what it claims.

If it works, should we use it?

Not surprisingly, lactation professionals appear to be reflexively opposed to its use. Its mere existence poses a serious challenge to the cherished lactivist beliefs that insufficient breastmilk is rare, that women who report it are “misperceiving” the size of their supply, and that “trusting” their bodies is the key to successful breastfeeding.

But if it turns out that the Mylee analyzer has a high rate of accuracy, they may quickly change their assessment. Why? Because it could be a huge revenue source for lactation consultants.

The device is slated to cost $349, well beyond the means of most women. Lactation consultants could purchase the device and charge a fee for testing a client. If they charged just $25 per analysis, they could earn back the cost of the device after only 14 tests; thereafter, the $25 per test would be pure profit.

Being able to do the analysis would almost certainly improve the popularity of the lactation consultant relative to her peers. Moreover, in the situation where the test indicated a normal Na/K ratio, lactation consultants could reassure patients with objective evidence that their supply was adequate and that they actually should trust their bodies. In contrast, if the test indicated a high Na/K ratio, women could be assured that low supply was biological, not lack of effort on their part. It is possible that such testing could help determine the efficacy in increasing supply of pumping regimens and galactologue supplements and medications.

Should anyone buy the device?

Even though the theory behind it is sound, I’d need to see much more scientific evidence of efficacy before I would recommend it for anyone. An accurate test could be very beneficial. An inaccurate test would be worse than useless.

Honestly, are there any bigger hypocrites than natural mothering advocates?

Their philosophy is based on the belief that childbirth and breastfeeding evolved to be perfect. They tell themselves and each other that women are perfectly “designed” (or evolved, if you prefer) to give birth vaginally without pain medication and therefore that must be best. Women are perfectly “designed” (or evolved, if you prefer) to breastfeed exclusively and for years at a time, so that must also be best. In nature, women co-slept with their babies, so — regardless of the demonstrated increased risk of death to babies — co-sleeping must be best. After all, anything that promotes breastfeeding is, by their definition, best for babies even if it kills them.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Why aren’t women who advocate slavish devotion to what “nature intended” for childbirth and breastfeeding equally insistent on early and frequent pregnancies?[/pullquote]

But fertility and child spacing were also “designed” by nature (or evolution, if you prefer). Here’s what natural fertility and child spacing looked like:

• Menarche was age 16 or so
• Childbearing began in the late teens
• Women could not control fertility
• The average woman experienced 8-10 pregnancies
• Life expectancy was 35 years

So why aren’t women who advocate slavish devotion to what “nature intended” for childbirth, breastfeeding and co-sleeping equally insistent on early and frequent pregnancies?

Shouldn’t every woman become sexually active within a year or so of menarche?

When sexually active, shouldn’t every woman eschew fertility control of any kind?

Shouldn’t childbearing start in the late teens?

Shouldn’t women be perpetually pregnant or nursing, only rarely having menstrual periods?

Shouldn’t every woman have 8-10 pregnancies or more?

Wait, what? That’s not convenient/desirable/compatible with contemporary lifestyles?

So? If convenience/desire/compatibility with contemporary lifestyle aren’t justifications for epidurals, formula feeding and infants sleeping in cribs, how can they be justifications for women to control fertility, delay childbearing and limit the number of children they have?

Isn’t there something fundamentally unnatural about any women who delays childbirth until her late twenties or even late thirties?

If it’s “selfish” to have an epidural or formula feed, isn’t it equally selfish to delay childbirth until you’ve found your soulmate?

Delaying childbearing for a career? There were no careers in nature.

Early and frequent pregnancies are harmful to women’s health? How could that be if women are “perfectly designed” to have early and frequent pregnancies?

Tell us, natural mothering advocates, if women are supposed to “trust” birth and breastfeeding, why shouldn’t they trust unhindered fertility and frequent childbearing?

Inquiring minds want to know!

It’s the central obsession at the heart of contemporary breastfeeding promotion, and it serves as a justification for the shaming tactics so beloved of lactivists.

It’s the fantasy that the formula industry is waging war on breastfeeding.

[pullquote align=”right” cite=”” link=””]Formula was not created as a substitute for breastfeeding; it was created to replace the raw animal milk women were already using as a substitute for breastfeeding.[/pullquote]

Don’t get me wrong; the formula industry is trying to make money. And, yes, decades ago they engaged in deceptive practices to convince women in developing countries to formula feed; but there was never a similar campaign in industrialized countries for a very simple reason — women couldn’t or wouldn’t breastfeed long before formula even existed.

Formula was not created as a substitute for breastfeeding; it was created to replace the raw animal milk women were already using as a substitute for breastfeeding.

As Jacqueline Wolf explains in the chapter Saving Babies and Mothers: Pioneering Efforts to Decrease Infant and Maternal Mortality, in the book Silent Victories: The History and Practice of Public Health in Twentieth Century:

The custom of feeding cows’ milk via rags, bottles, cans and jars to babies rather than putting them to the breast became increasingly common in the last quarter of the nineteenth century progressed… In 1912, disconcerted physicians complained bitterly that the breastfeeding duration rate had declined steadily since the mid-nineteenth century “and now it is largely a question as to whether the mother will nurse her baby at all. A 1912 survey in Chicago … corroborated the allegation. Sixty-one percent of those women fed their infants at least some cows’ milk within weeks of giving birth.

And the results were deadly:

The late nineteenth century urban milk supply killed tens of thousands of infants each year. Unpasteurized and unrefrigerated as it journeyed from rural dairy farmer to urban consumer for up to 72 hours. cows’ milk was commonly spoiled and bacteria-laden. Public health officials dramatically charged that in most U.S. cities, milk contained more bacteria than raw sewage …

Those death rates did not start falling until cows’ milk was replaced by infant formula, which more closely matches the composition of human milk, is uncontaminated and is very convenient to buy, store and use.

Breastfeeding, like most natural processes, has a high natural failure rate. Up to 15% of new mothers don’t make enough milk to fully nourish a growing baby, especially in the first few days after birth. In addition, breastfeeding can be difficult, painful, frustrating and incompatible with women’s work outside the home.

Infant formula finally made the widespread use of breastmilk supplements safe. It’s no different from birth control. The manufacturers of the Pill didn’t need to convince women to use birth control; they simply made birth control safe and effective.

The similarities don’t end there.

Why do formula manufacturers advertise? For the same reason that birth control manufacturers advertise: to claim market share.

Manufacturers of various formulations of The Pill, condoms and diaphragms aren’t engaged in a war on children. Women themselves WANT to regulate their fertility. They don’t want to subject themselves to a dozen pregnancies across a reproductive life and they don’t want to raise a dozen children. No one needs to convince women to prevent pregnancy; the market for birth control encompasses just about every woman of reproductive age in every country. The issue for women is not IF they are going to use birth control, but WHICH form of birth control they are going to use. That’s why purveyors of birth control advertise.

Formula manufacturers advertise for the same reason. The issue is not IF women are going to use formula; many will choose to do so regardless. The issue is which brand to use. It’s the same reason why formula companies give free samples of their product. Contrary to the lactivist fantasy that formula samples are aimed at seducing women away from breastfeeding, the industry is not worried about IF women will use formula; it’s concerned about WHICH formula brand they are going to use.

Lactivists have used the fantasy of formula manufacturers warring against breastfeeding to justify their tactics of grossly exaggerating the benefits of breastfeeding, pretending there are “risks” to formula feeding, invoking shaming language to pressure women into breastfeeding, and employing Orwellian programs like the “Baby Friendly Hospital Inititiative” to force new mothers to breastfeed. They believe they are waging war against the formula industry; the reality is that they waging war against women’s bodily autonomy.

Women use formula for the same reason that women use birth control; it allows them to determine when and how they use their reproductive organs. Lactivists oppose formula for the same reason that religious fundamentalists oppose birth control. Fundamentalists believe no woman should have sex unless there is a chance for pregnancy; lactivists believe no woman should give birth unless she plans to breastfeed.

In both cases, what is at stake is not the financial health of corporations, but the rights of women.