Emotional grooming is the practice of manipulating an individual into a position of trust, vulnerability and isolation for the purpose of exploitation.

It’s commonly used to describe the tactics preparatory to child sexual abuse, but it applies whenever a powerful person maneuvers another into a situation that benefits the former at the expense of the latter. Sadly, it is used all too often by midwives and lactation consultants to convince women to do what benefits the provider at the expense of the patient and her baby.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Distrustful of other providers? Isolated from family and friends? Totally dependent on the advice from the midwife or lactation consultant?  You may be a victim of emotional grooming.[/pullquote]

How can you tell? If you find that you have become distrustful of other providers, isolated from family and friends and utterly dependent on the advice from the midwife or lactation consultant, you may be a victim of emotional grooming.

There are three red flags:

Encouraging mistrust of other providers.

An ethical medical professional does not disparage other medical professionals. Ethical medical professionals work together for the benefit of patients. No obstetrician would encourage you to distrust your perinatologist, or express disdain for the medical philosophy of the endocrinologist who follows you for diabetes.

Ethical medical professionals depend on each other to provide you with the best possible care. That’s why it’s a warning sign if a midwife encourages you to distrust obstetricians or a lactation consultant encourages you to distrust pediatricians.

If there is a disagreement between professionals over your care, they should discuss it between themselves; you might even wish to be present to evaluate their differing points of view. If your midwife or lactation consultant is unwilling to do that, you should consider whether she is encouraging you to distrust other providers for her own benefit (to keep you as a patient, to deprive you of information that might lead to you questioning your recommendations) rather than for your benefit.

It is especially worrisome if she encourage you to lie to other medical professionals. An ethical professional will NEVER counsel you to lie to another provider. No doctor can advise you appropriately if you are lying in response to their questions. There is absolutely, positively no benefit to you from lying to a doctor about anything.

When a midwife encourages you to distrust an obstetrician, or when a lactation consultant encourages you to distrust a pediatrician she is trying to isolate you from others. Why? So she can keep control of you as a patient.

Claiming special knowledge.

Does your midwife claim that obstetricians have never seen an unmedicated vaginal birth? If you think about it for a moment, the claim is absurd. Even in the US, with high rates of C-section and epidural use, fully 68% of women give birth vaginally. Approximately 40% give birth without an epidural. Moreover, in 2019 the majority of obstetricians are women. They haven’t just seen thousands of labors, they’ve endured a few themselves.

There is no midwife who knows more about SAFE childbirth than an obstetrician. Sure, midwives may have tips and tricks for support, but that has nothing to do with safety.

Does your lactation consultant claim that pediatricians are ignorant of breastfeeding? That might have been true 30 years ago, when actively promoting breastfeeding first became a priority for pediatricians, but it’s not true in 2019. In addition, the majority of pediatricians are women and many have breastfed their own children.

There is no lactation consultant who knows more about SAFE breastfeeding than a pediatrician. Sure, lactation consultants may have tips and tricks for support, but that has nothing to do with safety.

An ethical medical professional would never encourage you to risk your health or your baby’s health. An ethical professional wouldn’t tell you that you were brave, or a warrior mama, or demonstrating your trust in birth. An ethical medical professional would never tell you that you are “designed” to breastfeed. Those are all forms of emotional manipulation employed to strengthen the midwife or lactation consultant’s control over you for her benefit, not for yours.

Advocating ignoring relatives and friends.

The primary purpose of emotional grooming by midwives and lactation consultants is to isolate women and leave them vulnerable. Women in labor, and postpartum women are vulnerable by definition, leaving them easy to manipulate. But most women have partners, parents and friends who are prepared to advocate for them. Since relatives and friends aren’t as vulnerable, they can and will push back against midwifery and lactation recommendations that are unsafe both physically and psychologically.

One of the hallmarks of emotional grooming in any setting, not just a medical setting, is the efforts of the manipulator to separate you from the people who care most about you. Encouraging you to distrust your family and friends (“They aren’t as educated about childbirth as we are.” “They are steeped in a culture of fear.” “They are sheeple who cannot imagine defying authority figures.”) is encouraging an emotional barrier between yourself and those closest to you. The goal? Increasing the midwife’s or lactation consultant’s ability to manipulate you into doing what she wants, not what is best for you and your baby.

Do you trust your midwife? Do you think your lactation consultant knows what’s best for your baby? That’s great, but just be sure they are not emotionally manipulating you by encouraging distrust of other medical professionals, by insisting that they have knowledge other providers lack or by isolating you from family and friends. That’s not medical care; it’s emotional grooming and it’s harmful for you and your baby.

Lawyer and birth rights activist Bashi Hazard refuses to answer the question I posed:

What’s the difference between a doctor who performs a painful exam over a woman’s protests and a midwife who denies an epidural over a woman’s protests?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The ugly truth is that Hazard and Hill aren’t interested in what women want; they’re only interested in what they and their friends want.[/pullquote]

In the meantime, journalist Milli Hill, always desperate for attention, has joined the fray.

Hill:

I don’t really understand who ultimately gains from all the effort though? What is their goal – or who is getting their pockets lined – or both?

Hazard:

Well, take the NRA for example. How do you manage to keep selling guns to teenagers when your community is coping with 30-40 school mass shootings a year? By keeping the public on side through floods of “emotional messaging”: (1) Affirm their outrage (2) Tell them what to think

They seem to be under the mistaken impression that the bullshit with which they baffle their gullible followers will work on me.

Feminist academics have been exploring midwifery abuse of power for decades.

Among the most influential commentators on the subject are Ellen Annandale and Judith Clark, authors of the widely quoted paper, What is gender? Feminist theory and the sociology of human reproduction published in Sociology of Health & Illness Vol. 18, No. 1, 1996. The paper is long and filled with academic jargon, but has important insights that have created controversy among feminist theorists:

…[T]he lived experience of midwifery … is revealed only as the largely unresearched antithesis of obstetrics. An alternative is called into existence in powerful and convincing terms, while at the same time its central precepts (such as ‘women controlled’, ‘natural birth’) are vaguely drawn and in practical terms carry little meaning.

In other words, contemporary midwifery is unscientific and based on reflexive defiance. How did the it get to this point? Annandale and Clark believe that it starts with biological essentialism. Biological essentialism perpetuates women’s oppression by validating men’s belief that women are emotional and irrational. Or as Annandale and Clark write:

… Thus … reproduction is still centred for women and put on the agenda as if it were central to all women’s lives. This may serve to lock women into reproductive roles which may be politically problematic since the centrality of reproduction, contraception and childbirth to biomedicine is transferred to women’s experiences. This may be the reality of their experience, but equally importantly, it may not. To a certain extent this may be seen as an unavoidable consequence of a critique which appears as if it must engage the dichotomies of biomedicine to develop its own narrative.

Not only are the assumptions of biological essentialism wrong, they are also elitist:

… The charge of elitism evidenced in the privileged white middle-class voice of much research, and the silence around differences between women, applies well to Barbara Katz Rothman’s influential 1982 work … which ends with an implicit call for a home-based natural birth experience …. This is made in joyous terms with little recognition that many women may not be in the position to avail themselves of such an ‘alternative’ even if they wanted to.

Annandale and Clark ask a critical question about the new midwifery. Are midwives “with women” or exploiting women for their own ends?

If we conceive of power as a fundamentally male preserve we are led to gloss over ways in which women may exert power over others, including other women. In these terms, as recent institutional reforms stimulate community midwifery midwives may begin to consider the notion of affinity with women embedded in such concepts as ‘continuity of care’ … as masking the potential exploitation of midwives by their clients.

This is what Bashi Hazard and Milli Hill refuse to acknowledge. And because they cannot accept that midwives could abuse their power, they feel free to ignore the women who are abused by midwives.

One Twitter commentor wrote:

This happened to me and it certainly felt like assault. Midwife/doctor whoever is denying the pain relief, there needs to be serious concequences, it is a human right to have pain relief during childbirth, and in denying pain relief they are deliberately violating a human right.

Another wrote:

I’d also like to see them pulled up for ‘too early to have an epidural’ or the ‘let’s see how it goes’ routine. It’s nonsense- childbirth will generally get worse before it gets better and these tactics are designed to get the woman past the point of being able to have one.

The ugly truth is that Hazard and Hill aren’t interested in what women want; they’re only interested in what they and their friends want. And they’ll say and do anything — no matter whom they hurt in the process — to get it.

They know their position is indefensible so they try to divert with name calling and lies. That won’t work any more.

Yesterday I asked:

What’s the difference between a doctor who performs a painful exam over a woman’s protests and a midwife who denies an epidural over a woman’s protests?

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Hazard’s pious appeals are not about women; they’re about midwifery market-share.[/perfectpullquote]

I was responding to the claim by human rights lawyer Bashi Hazard that an increasing number of women are likening their experience of childbirth to assault by doctors.

I also posed the question to her directly on Twitter and she “responded” in the fashion typical of those who have been caught in hypocrisy — with a desperate effort to deflect:

I have arrived. A US RWNJ troll who claims to be an obstetrician has thrown down an imaginary gauntlet at me!

Is this woman really a lawyer? Most lawyers I know do research before responding so they won’t be caught uninformed. Hazard clearly didn’t bother.

I asked again:

If you care about women, you would be concerned about the widespread problem of midwives denying women epidurals. It seems you don’t.

Once again she tried to deflect:

Its you I dont care about. You are not an obstetrician. You are a troll and a RWNJ and a hired gun coming out of a country with a leader who bullies, trolls, lies and manipulates facts much like you. Your white self importance and entitlement is offensive. I waste no time on it.

Sure! If she didn’t care, she wouldn’t have responded, but apparently she was stung … as I intended.

The ugly truth — which Hazard is desperately trying to obscure — is that efforts to claim obstetricians commit assault/violence/birthrape have little if anything to do with women’s wellbeing and everything to do with midwives’ desperation to claw back market share.

Midwifery is an industry and midwives demonize their competitors. Indeed, much of midwifery philosophy is just reflexive (and unreflective) defiance of obstetricians:

Since obstetricians medicalize childbirth to make it safer, midwives de-medicalize it to make it more enjoyable, and, for added impact, declare childbirth was safe before obstetricians got involved.

Since obstetricians offer pain relief, midwives proclaim that pain improves the experience, simultaneously testing one’s mettle and making childbirth safer.

Since obstetricians whisk babies off to pediatricians to be sure they are healthy, midwives claim (without evidence) that skin to skin contact between mother and infant in the first moments after birth is crucial to creating a lifelong bond.

Since obstetricians placed the highest value on a healthy mother and a healthy baby, midwives place the highest value on a fulfilling birth experience.

In other words, no matter what obstetricians offer, midwives insist that it is unnecessary, disempowering and harmful. Midwives can thereby wrest childbirth back from doctors and give it to those to whom they believed it rightly belongs … the midwives themselves.

Wait, what? You think childbirth should belong to women? How naive. That would require holding midwives to account for their egregious behavior and apparently that’s not allowed.

A recent incident in New Zealand is emblematic of midwifery assault on women: Midwife disciplined after pretending to give woman pain relief during labour.

…[I]nstead of giving the woman the agreed pain relief of pethidine, the midwife gave her intravenous saline as a placebo but told her it was the pethidine.

…[T]he midwife said she “believed in the placebo effect”.

It gets worse. According to the midwife:

The way [the woman] was presenting led me to believe that she was transitional. Knowing this, I felt it was in the best interests of the baby not to give pethidine,” the midwife said.

“However, in the best interests of [the woman], I was to give her a sense of support and help in a difficult time, therefore I administered normal saline, leading her to believe it was Pethidine.

“I knew it would do no harm, and that pethidine could still be administered at any stage.

What did Bashi Hazard and her organization have to say about that? As far as I can determine, absolutely nothing!

Hazard has revealed her true goal — clawing back turf — in an article she wrote for Midwifery Today entitled Equality for Midwives:

Despite the knowledge and skills that traditional midwives have always used to serve their communities, there were medical emergencies that could arise in childbirth that they could not solve. Antibiotics, anti-hemorrhagic medicine, assisted and surgical deliveries and other medical technologies can prevent many of those deaths, and access to such technologies has saved many lives and massively reduced maternal and neonatal loss since their invention. But the terms on which these tools were offered to women, in the US and in many other places, created new forms of risk as all women were asked to place themselves in the care of medical professionals for pregnancy and birth, whether or not they needed medical treatment. Midwives were often disempowered (my emphasis)…

Midwives lost turf and income and they want it back:

Inequality exists in economics when doctors are rich, while midwives are poor. The valuing of, and compensation for, midwifery services should appropriately recognize their contribution to maternal health, enable midwives to continue in the field and develop experience and skills and construct midwifery as a stable profession that enables a woman to support her family, as doctors are able to support theirs.

Hazard’s pious appeals about assault in childbirth are not about women; they’re about market-share. Her goal is not the empowerment of women, but the enrichment of midwives.

That’s why Hazard has no interest in protecting women from assault by midwives, and was stung when I pointed out her hypocrisy. She felt compelled to respond, but her response merely confirmed my claims.

It happened 37 years ago, but I never forgot.

I was on my medical school obstetrics rotation and had just watched the birth of a baby. The mother had sustained a large second degree tear and the obstetrician was repairing it … without anesthetic. It would have been easy to give the mother local anesthesia but the doctor didn’t do it. The mother was screaming in pain yet the doctor was telling her she was “doing great.” There was no reason for the doctor to forgo the anesthetic beyond the fact that he couldn’t be bothered to administer it and wait for it to take effect.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]What’s the difference between a doctor who performs a painful exam over a woman’s protests and a midwife who denies an epidural over a woman’s protests?[/pullquote]

The doctor’s behavior was inexcusable.

That ugly incident came to mind as I read Assault during childbirth increasingly common in Australia says International human rights lawyer:

International human rights lawyer Bashi Hazard says an increasing number of devastated Australian women are likening their experience of childbirth to assault.

For example:

Brisbane mum Hayley Hackenberg, 34, was diagnosed with post-traumatic stress syndrome three months after giving birth to her second child Tobin.

“I was assaulted,” she says, tears filling her eyes. “It made me feel vulnerable and violated.” …

Hackenberg recalls a doctor coming into the room and telling her she was going to do a vaginal examination – in between talking to a midwife about what she was going to have for dinner.

“It really, really hurt, sending pain deep into my stomach. I asked her to stop, I screamed for her to stop, I whispered for her to stop, but she didn’t,” Hackenberg says. “She was looking at the midwife.”

At this point Hackenberg says she told the midwife: “I can’t do this anymore, I want a caesarean”.

She thought about suing the doctor:

She also spoke with a lawyer who said she could press criminal charges for assault but she decided not to.

Lawyer Hazard considers this situation, a patient in serious pain and a provider doing nothing to mitigate or relieve it, to be assault.

Hazard says the numbers affected are significantly higher and increasing but legal action for mental health issues and nervous shock cannot be brought without physical injury and women are often told there is no real injury.

Which raises the question:

What’s the difference between a doctor who performs a painful vaginal exam over a woman’s protests, all the while insisting she is “doing fine” and a midwife who delays or denies an epidural over a woman’s protests, all the while insisting that she is “doing fine.”?

There is no difference.

The practice is shockingly common:

A forum post that asked mothers “anyone else tricked out of epidural?” attracted 1,000 replies in under two weeks…

For example:

When Murphy entered the maternity ward to give birth to her daughter in February 2016, she was told that she couldn’t have an epidural until she was in active labor. When she entered labor, she requested one repeatedly. She never received it…

Months later, she questioned her care at a meeting with the Head of Midwifery at her ward. She was told that the staff had made a clinical decision not to give her the pain relief she requested. They thought she was going to deliver before it took effect.

And:

Danielle … planned to have an epidural. She even included it in her birth plan. Instead, she was refused all pain relief—including gas and air (a.k.a. nitrous oxide, which is widely used in the UK for pain relief during labor).

“Firstly because they told me I wasn’t in labor and to go home half an hour away,” [she] tells Broadly. “Then I was continually told over the phone I still wasn’t in labor [even though] I was in horrendous pain.” When she was finally examined, midwives told her it was too late for an epidural—or even gas and air.

If painful exams and failure to respond to patient entreaties is assault, midwives who delay or deny requested epidurals have also committed assault.

Human rights lawyer Bashi Hazard is correct that assault of women in labor is unacceptable.

Hazard claims hospital staff suffer excessive fear of liability and disciplinary action, so their response is to be more coercive to a mums-to-be as they deliver their babies.

“They no longer perceive the woman as their priority,” Hazard insists. “It is a really toxic workplace environment with everyone ready to point the finger at everyone else.”

In the case from my medical school rotation, the doctor denied the mother local anesthesia for a laceration repair because he didn’t want to be bothered and he believed the woman “didn’t need” pain relief.

When midwives delay or deny epidurals it’s because they don’t want to be bothered and because they believe women “don’t need” pain relief.

If Hazard and other birth activists truly believe that ignoring women’s entreaties about pain is assault, they should call out and even prosecute the midwives who do exactly the same thing.

You cannot understand the contemporary discourse around mothering in the US without understanding this central reality:

Every woman is the hero of her own mothering story.

That’s the essence of the mommy-wars. It has nothing to do with children, although children are ostensibly the focus; it has nothing to do with science, although science is often subverted for the purpose; it has everything to do with women and how they wish to see themselves, especially in comparison with other women.

[pullquote align=”right”]The mommy wars are fights to the emotional death so some mothers can claim heroic status.[/pullquote]

Every time I write about about shaming of formula feeding mothers, I am startled yet again by a total lack of lactivist regret. Lactivists aren’t moved to ask how they might craft a message that promotes breastfeeding without shaming women who can’t or don’t wish to breastfeed. That’s hardly surprising, though, if you understand that one of the central motivations of lactivism in the US is to portray the breastfeeding mother as a hero.

The mother as quest hero is at the heart of nearly all parenting movements based in part, or in whole, on pseudoscience.

Consider this description of a heroic quest:

• The call to adventure: The hero is “called” by [her]self or others to complete a task that will take [her] away from [her] regular “role” in [her] own society.
• The entry into the unknown: As a result of the call, the hero must leave the safety of [her] own known community and venture into a world of unknown dangers.
• Facing tests and trials: The hero faces a number of challenges on [her] journey… Heroes are often tempted to give up or give in.
• Sages: All heroes have guides to receive unexpected help on their journey…
• A supreme ordeal: This is the most difficult challenge or obstacle that the hero faces. Completing and overcoming this “trial” marks the end of the “testing” stage where the hero had to prove [her] worth…
• The return: The hero [her]self receives a reward of honour, acknowledgement, respect and perhaps love for [her] efforts…

Compare that to the classic “birth story” so beloved of birth bloggers, midwives and doulas. The mother is “called” to have an unmedicated vaginal birth and prepares by doing “her research.” She leaves the safety and comforts of medicated hospital birth. She faces tests and trials: refusal of standard preventive tests and interventions, arguments with relatives and friends about the wisdom of her choices, and the attitudes of hospital personnel who are nearly always constructed as unsupportive. She is tempted with offers of pain relief and C-section. Her midwife and her doula are sages who guide her on her quest. The supreme ordeal is navigating labor (the longer and more excruciating the better; the best is to ignore calls that your child is at risk) and “achieving” an unmedicated vaginal birth (preferably with minimal or no vaginal tearing). The hero receives honor, acknowledgment and respect for her achievement. Most importantly, she emerges “empowered.”

The mother is always the hero of her children’s birth stories, and by her heroism, she conveys her superiority over other mothers. Of course, for a mother to be a hero, unmedicated vaginal birth must be vastly superior. It isn’t superior at all, so birth activists subvert science to pretend that it is.

The heroic mother myth is at the heart of contemporary lactivism, where the mother faces pain, inadequate milk supply, and inconvenience, braves the temptation of formula feeding, is guided by a lactation consultant and achieves the quest of not a single drop of formula ever crossing her child’s lips. In order for a mother to be a hero, breastmilk must be portrayed as vastly superior to infant formula. It isn’t; in industrialized countries, the benefits are trivial, but lactivists subvert science to pretend that breastfeeding provides tremendous, lifelong benefits.

Even anti-vaccination advocacy depends on the quest trope. The mother goes on a journey of discovery by reading anti-vax screeds and websites, faces the pressures of relatives, friends and medical professionals, triumphantly refuses to vaccinate, and receives honor and acknowledgement in the anti-vax community for her heroism.

If the heroic mother fantasy affected only those who sought to make themselves mothering heroes, there would be no problem. Unfortunately, their efforts threaten two vulnerable groups. The first, and by far the most important, are children. Sadly, they serve as little more than props in the quest story. They exist to be acted upon and their actual well being is irrelevant.

Hence a natural childbirth aficionado will risk her child’s health and sometimes even her child’s life to complete her heroic quest. A lactivist will let her baby cry desperately in hunger and even let him starve, sometimes nearly to death, in order to complete her lactation quest. Anti-vax parents live in a dream world unmoored from reality where those who expose their children to harm are heroes.

The other group affected by the fantasy of the heroic mothering quest is the women who don’t view mothering as a quest. They can and should ignore those women who are desperate to cast themselves as heroes, but that’s harder than you might think. Why? Because the quest mothers have hijacked public health messages, particularly in the area of breastfeeding.

A heroic mothering quest appears to require shaming women who make different choices. That’s why lactivists don’t ask how breastfeeding promotion might be modified to minimize shaming. They WANT other mothers to be ashamed; they’re HAPPY they are ashamed; the last thing they want to do is to mitigate that shame. If mothers who formula feed aren’t failures at the quest, how can mothers who breastfeed be heroes?

Framing mothering as a quest has NOTHING to do with actually mothering children. It has NOTHING to do with science. The mommy wars are fights to the emotional death so some can claim heroic status while grinding others into the dust. It’s ugly; it’s wrong; and we should refuse to countenance it.

Natural mothering advocates like to imply that the natural is political. For example, they absurdly claim “peace on earth begins with birth.” The implication is that because we’ve deviated from natural childbirth, we’ve been punished with an epidemic of violence. It’s nonsensical because for most of human existence, childbirth has been entirely natural and violence was far more common in the past than it is today.

But when it comes to mothering, the natural IS political. The “natural” in natural mothering has very little to do with what actually happened in nature, but is a cultural construct meant to control the behavior of women.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Natural mothering is political, not because it improves the world, but because it designed to suppress women.[/pullquote]

That’s among the arguments made by Harriet Pattison, PhD of Liverpool Hope University in her chapter The Natural Child from the book Childhood Today.

Both childhood and nature are cultural constructs that have little if anything to do with childhood in nature.

Scholars note that our beliefs about childhood in nature are cultural, without reference to what actually happened in nature.

… [T]he present-day view of childhood is overwhelmingly that childhood is not natural … a social construct. This means that our knowledge of children is shaped not by understandings inherent to the state of childhood but by much wider forces… Beliefs about children … what they need and how to treat them – come not from general facts about children but from interpretations made through … politics, economics, culture, philosophy and religion.

Our view of nature itself is culturally determined.

…[N]ature, like childhood, is not a fixed, immutable entity but a responsive concept, tied to our wider thinking, to our political and social concerns … What also becomes simultaneously clear is that if nature is a construct of human thought then any understanding of nature is liable to be a changeable, shifting phenomenon, open to making and remaking in varied and restless forms

Why does it matter how women mothered children in nature?

If childhood can be successfully grounded in such a solid base as that of nature, then considerable control has simultaneously been gained over … how it should be enacted. Thus the contention here is that new, contemporary calls to natural childhood and natural children embody political desires …

Natural mothering is about the politics of controlling women. Perhaps the biggest irony of this effort is that self-proclaimed natural mothering “experts” invoke science to argue about what is supposedly the province of nature:

The paradox however is … that the scientifically objectified natural child ‘has helped to create an intellectual climate in which childhood was no longer seen to occur naturally. It did this by promoting the idea that childhood needed the attention and intervention of experts’. So we have moved from the natural child whose development is governed by a pre-determined unfolding biology to a child whose development has to be carefully nurtured and managed by trained specialists.

University College London psychoanalyst Ruth McCall amplifies these themes in her chapter Pyschoanalysis and Feminism: A Modern Perspective from the book The Unconscious in Social and Political Life.

Currently there is a fashion for attachment parenting, a mode of looking after babies with maximal psychological empathy and long-term physical closeness. The American paediatrician William Sears and his wife Martha explicitly developed attachment parenting in response to Bowlby’s research findings and advocate that there is no higher purpose for a woman than as mother … Some academic feminists are aghast at this turn. Harvard gynaecologist Amy Tuteur has stated that “Attachment parenting amounts to a new subjection of the woman’s body under social control,” and a recent book by Élisabeth Badinter, The Conflict: How Modern Motherhood Undermines the Status of Women, specifically attacks attachment parenting for its retrogressive effects on women’s lives.

But this is not merely a theoretical issue. It leads to tremendous suffering for women.

The terrible feelings of failure and regret that are experienced by women who have difficult births or who cannot or do not choose to breastfeed are very significant. Attachment parenting, designed to be a liberal alternative to nineteenth-century regimens of controlled feeding and crying can also produce anguish.

As Petra Buskens notes in The Impossibility of “Natural Parenting” for Modern Mothers:

Numerous histories of “the family” show us that intensive, romanticized caregiving carried out by biological mothers in the private sphere is an “invention” of modern economic and political arrangements. It was only with the division of public and private and the shift from a domestic to an industrial economy, that mothers were cordoned off to a special occupation called “Motherhood.”

Prior to this, women mothered with a community of men, women, and children and did so in and around a myriad of other subsistence oriented tasks. However, with the social changes brought about by the creation of a public sphere (populated by male citizens) together with industrialization and a free-market economy, women in western societies were no longer welcome to participate in economic and social life; instead they were sequestered to the private sphere as glorified mothers … This pedestal was a dubious and double-edged position generating a situation of profound, albeit romanticized, exclusion.

It reflects political and cultural conservativism:

The emphasis on maternal nurture … provides an invisible subtext of romantic opposition to western modernity. In other words, contained within this radical critique is a thinly veiled conservatism concerning the “natural” place of women … As with earlier historical periods of modernizing social change, mothers thus come to represent … the “traditional” within the “modern.”

William Sears is a paradigmatic example of this thinking:

Sears is specifically opposed to mother’s working outside the home and encourages 24-hour embodied care … Together they amount to an utterly exhausting regime of caregiving and patience for the mother. Her role as isolated caregiver precludes her participation in both paid work and socializing but we are assured this is a “natural” and “traditional” state of affairs. One wonders how such a blatant ignorance of history could go unnoticed by both Sears and his readers, but we have only to remember the emotional power of the word “mother.” In the name of this word, Sears manages to reconstruct the past and foreclose much of the future for new mothers.

The bottom line is that natural mothering is political, not because it improves the world, but because it designed to suppress women. Natural mothering has never been about what’s good for babies; it’s about forcing women back into the home in service to tradition but under the guise of “nature.”

I’ve written over and over again about the way that lactation professionals lie to women, promoting breastfeeding over the wellbeing of mothers and babies.

Every time a lactation professional claims insufficient breastmilk is rare when it is common, she lies.
Every time a lactation professional claims second night syndrome isn’t hunger, she lies.
Every time a lactation professional says neonatal stomach volume is 5-7 ml when it is 20+ ml, she lies.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Real medical professionals don’t punish colleagues for telling the truth about side effects. Lactation professionals prefer lying.[/pullquote]

But if you want to understand how integral lying is to lactivism, look no further than the case of Midwife Cath, an Australian midwife now facing disciplinary action because dared to tell the truth.

… Curtin has been ordered to undergo additional training by the Nursing and Midwifery Board of Australia.

The order comes after five people complained about a post Curtin made on social media about breast feeding.

Let’s think about that for a moment. Anti-vax doctors routinely question vaccination on social media but they aren’t disciplined.

Chiropractors and homeopaths routinely post self-serving nonsense on social media but they aren’t disciplined.

And midwives themselves routinely question obstetric standards of practice on social media, but they aren’t disciplined.

Why, because health professionals have a right to freedom of speech.

So what did Midwife Cath do that was “worse” than that?

In the [Instagram] post, Curtin wrote “The thing with lactation is we ALL can lactate but we ALL don’t lactate the same amount… don’t feel bad if you can’t squirt this much milk”.

The Instagram post continues, “Rather than babies going hungry or sitting on a pumping machine (which doesn’t increase your milk supply by the way) remember that #fedisbest”.

Put in other terms, Curtin was suggesting women feed their babies with formula rather than letting them go hungry waiting for breastmilk to come through.

How dare she tell the truth about the fact that insufficient breastmilk is common?

No less an authority than Alison Stuebe, MD of the Academy of Breastfeeding Medicine has acknowledged:

Delayed onset of lactogenesis is common, affecting 44% of first-time mothers in one study, and 1/3 of these infants lost >10% of their birth weight. This suggests that 15% of infants — about 1 in 7 breastfed babies — will have an indication for supplementation.

How dare she tell the truth that there is no evidence that pumping (which is not natural) leads to milk coming in faster? It’s possible though no one has ever shown it to be true.

How dare she tell women that judicious formula supplementation in the early days after birth IMPROVES the chances of exclusive, extended breastfeeding?

According to the paper The Effect of Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota: A Randomized Clinical Trial:

[T]hese results suggest that using ELF in a carefully structured, temporary manner may not interfere with breastfeeding or maternal experience in the first month or have a negative impact on intestinal microbiota… Using small volumes of formula on a temporary basis for newborns with pronounced weight loss may have the potential to help clinicians and mothers provide the nutritional volume needed by babies without interfering with duration of breastfeeding or with the health benefits achieved from longer breastfeeding duration.

No matter. Lactivists believe it is better to lie to women and let their babies starve.

But probably Midwife Cath’s most unforgivable sin is that she adopted the slogan of the “other side,” Fed Is Best.

Why is that her most egregious offense? Because contemporary breastfeeding promotion is about market share and the economic benefits for lactation professionals. They imagine themselves to be in a turf war with formula companies and they strive to win that war at all costs — even if the cost is collateral damage to babies: letting them starve, sustain brain injuries and die rather than give them lifesaving formula.

How is Midwife Cath to be punished?

She must indoctinated to ensure that mothers aren’t told the truth.

[She] must be mentored by another registered midwife in relation to contemporary best evidence of infant feeding (breast feeding and bottle feeding), safe sleeping and advertising responsibility (including endorsement advertising)…

The mentoring must comprise a minimum of six sessions with each session being of one hour duration occurring over a six month period.

George Orwell couldn’t have come up with a better form of “discipline.”

To understand just how immoral such behavior is consider:

What if doctors who questioned the benefits of routine episiotomy and feared the risks had been “disciplined” for refusing to lie to patients?

Women would still be getting routine episiotomies with the increased tearing that results.

What if doctors who discovered that ulcers were caused by bacteria were “disciplined” for refusing to pretend to patients that anti-acids were the cure?

The toll in pain, suffering and death would never have been decreased.

What if doctors who questioned the benefits of hormone replacement therapy for postmenopausal women were “disciplined” for refusing to lie and tell patients that the benefits outweighed the risks?

The breast cancer rate would have continued to rise.

Real medical professionals don’t censor their colleagues, because real medical professionals understand that questioning received wisdom is integral to providing the best possible care.

But lactation professionals aren’t real medical professionals; they are self-promoters. That’s why a midwife who dares to tell patients the truth about breastfeeding must be punished.

Every complex problem has a simple solution … and it is wrong.

According to lactation professionals, the “problem” of low breastfeeding rates has a simple solution. Just end formula advertising and societal pressure to bottlefeed and all women would breastfeed successfully, exclusively and for extended periods. They’re wrong. But even worse, they’ve leveraged their “simple solution” to disempower mothers.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactation professionals arrogate authority over breastfeeding to themselves by de-legitimizing doctors and mothers.[/pullquote]

That’s what sociologist Emma Head explains in Understanding Mothers’ Infant Feeding Decisions and Practices.

The first part of this paper discusses the development of social research that focuses on the promotion of breastfeeding in public health campaigns and by health professionals. I argue that this work tends to conceptualize the choices of women as constrained by overbearing public health messages which need to be ‘rolled back’ to enable women to make feeding decisions according to their own wishes.

But that’s wrong.

The broad exploration of infant feeding found in social research—one that recognizes its temporal, embodied, and emotional dimensions and that it takes place in the wider context of specific health and policy regimes—is thus a challenge for more simplistic accounts which focus on changing attitudes or behaviors in an individualist way.

I can hear lactivists now: “But, but the SCIENCE!”

Critiques of the way that ideas of risk and science have dominated debates around infant feeding are based around two main arguments. The first of these questions the validity of the scientific evidence that supports the promotion of breastfeeding. Following on from this, the second is concerned with the restrictions placed on women’s abilities to make meaningful choices around infant feeding that the current formulation of health promotion supports.

Specifically:

[T]he promotion of breastfeeding on scientific grounds can be understood “… as the outcome of a cultural process in which the authority of science and medicine is borrowed by lobbyists and campaigners”, resulting in the diminishing of other forms of authority and the “de-authorization” of the parent.

Lactation professionals de-legitimize doctors by claiming they “don’t understand” breastfeeding and de-legitimize mothers by claiming they cannot resist formula advertising and cultural messaging. It’s not a coincidence that lactation professionals imagine that ONLY they have a clear-eyed understanding of infant feeding choices.

Curiously, lactation professionals ignore the pressure that they bring to bear on women.

…[O]ver time the constraints on choice around infant feeding have increased so the presentation of breastfeeding has become more of a directive than a choice. Knaak identifies how the ‘choice’ to breastfeed has become increasingly pressured as it is not just physical health outcomes that are linked to breastfeeding but “increasingly strong interconnections” are made with mother-infant bonding. This adds an additional pressure for women negotiating infant feeding and means their choices are constrained because formula feeding is represented negatively.

Moreover, in contrast to lactation professionals’ simplistic representation of infant feeding decisions, there is far more involved than formula advertising and the presence or absence of cultural support.

The gap between public health promotion and women’s experiences adds weight to the recommendation that those promoting breastfeeding should try to roll back the moralization of infant feeding and, more broadly, that the politicization of parenting needs to be undone.

That such a gap exists is largely the result of lactation professionals’ efforts to de-legitimize women’s experiences of and feelings about breastfeeding. Because lactation professionals have chosen to pretend that breastfeeding is perfect, any less than perfect breastfeeding experience must be ascribed to the failure of women to try hard enough, their failure to resist formula advertising and their failure to reject cultural support for formula feeding. Perhaps the most egregious example of the disempowering and de-legitimization of mothers is the entity of “perceived insufficient milk supply” as if women can’t be trusted to tell that their beloved babies are starving.

Lactation professionals arrogate authority over breastfeeding to themselves by claiming that neither doctors nor mothers can be trusted to understand breastfeeding. The result has been a disaster for babies — exclusive breastfeeding is now the leading risk factor for newborn hospital readmission — and a source of soul searing guilt for mothers — who are evaluated by lactation professionals only on their willingness to knuckle under.

The bottom line is that public promotion of breastfeeding, particularly within hospitals and by government agencies, has NOT been shown to be beneficial to babies and mothers and has actually been shown to be harmful. But this has never been about babies and it certainly isn’t about mothers. Breastfeeding promotion is about building the authority of lactation professionals by de-legimitizing doctors and mothers. The babies who are harmed are just acceptable collateral damage.

That has to end. It’s time for mothers to take back their authority from lactation professionals. Only then will women be truly empowered to make the infant feeding decisions that are right for their babies and themselves.

On Monday I wrote about the pseudoscience of bonding.

It pseudoscience with a purpose. The purpose is to control mothers.

When the contemporary medicalization of attachment was proposed in the late 1970’s, there was no evidence we were experiencing an epidemic of “detached” children. Today, in the late 2010’s, it’s clear that the extensive implementation of bonding ideology hasn’t led to any improvement in children’s mental health. So why have so many parenting professionals embraced the nonsensical idea that mother-infant attachment requires ritualized behaviors at birth and in the following days and weeks?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The medicalization of attachment benefits the natural parenting industry. It harms mothers and babies, but who really cares about them?[/pullquote]

Sociology Professor Mary Ann Kanieski addressed this issue in her paper Securing attachment: The shifting medicalisation of attachment and attachment disorders.

She starts with an ironic observation:

Scholars have argued that mothers have been subject to intensifying regimes of medicalisation in our society. While many feminists have focused on the medicalisation of reproduction and childbirth, other theorists have observed the ways in which medical expertise has attempted to regulate women’s behaviour in their roles as mothers. These perspectives have shed great light on the ways in which motherhood has become an experience that is dictated and regulated by external authorities.

Natural parenting advocates, attempting to de-medicalize childbirth, have medicalized attachment as justification.

It fits into the trend of surveillance medicine:

Under surveillance medicine, the attempt to distinguish between health and illness has been transformed into a search for risk factors that are probabilistically associated with the development of illness… When risk factors are found to be present, individuals are impelled to reduce their risk factors, often through lifestyle changes, in the promise of reducing disease. Failure to take action can be viewed as a moral failing resulting in individuals being held responsible for their own health … Individuals must be constantly monitored for the presence of risk factors as health is viewed precariously. Owing to the difficulty of surveying a large population, surveillance medicine requires that individuals be taught to monitor themselves for the risk factors of disease.

It is difficult to overestimate the impact of this changing perception of illness. Previously illness was viewed as something that happened randomly. Now illness is viewed — incorrectly — as something that only happens to people at risk who do not take steps to reduce their risk. We have created a culture of “wellness” that falsely reassures people they can control their own health and therefore are responsible for their own illness. All they need to do is trust “wellness” experts, buy their books and supplements and use their nonsensical — chiropractic, homeopathic — services.

How has that played out in mothering?

We have created a culture of “naturalness” — parenting “experts,” midwives, doulas, lactation consultants —that falsely reassures mothers that they can control the health (and IQ!) of their children by trusting “naturalness” experts, buying their books and supplements and using their expensive services. Why? To convince mothers that their attachment to their babies is precarious and must be constantly monitored for “risk factors.” Because it is difficult to constantly survey a large population, surveillance of mothers requires that individuals be taught to monitor themselves, constantly seeking to reduce the “risk factors.” Any women who refuses to behave in concert with the surveillance regime is labeled as lazy, selfish and a bad mother.

Because attachment came to be a protective factor as well as a risk factor, the aim of achieving secure attachment in children encouraged mothers to engage in intensive mothering as a means of achieving the benefits of secure attachment and avoiding the risks of less secure attachment. To be a responsible mother meant that one needed to be a sensitive, responsive mother. Mothers were taught to monitor themselves in relation to their behaviour towards their children as advice regarding attachment and bonding …

The ironies abound. Women are taught by midwives and doulas that rejecting the medicalization of childbirth promotes bonding, but that only makes sense if you medicalize attachment as precarious, contingent on risk factors — medicalized birth is supposedly a risk factor — and requiring constant expert maternal surveillance and self-surveillance to implement.

Women are taught by lactation professionals that rejecting the medicalization of infant feeding (formula) promotes bonding, but that only makes sense if you medicalize attachment as precarious, contingent on risk factors — formula feeding is supposedly a risk factor — and requiring constant expert maternal surveillance and self-surveillance to implement.

Women are taught by attachment parenting experts that rejecting careers and work outside the home in favor of “wearing” babies promotes bonding, but that only makes sense if you medicalize attachment as precarious, contingent on risk factors — any maternal separation no matter how short is supposedly a risk factor — and requiring constant maternal surveillance and self-surveillance to implement.

But perhaps the biggest irony is this: attachment occurs naturally and there’s no evidence that it requires experts, rituals or self-surveillance.

In contrast to childbirth, which has a high natural death rate, and breastfeeding, which has a high natural failure rate, attachment has a very low natural failure rate. While complications of childbirth and breastfeeding are common, complications of attachment are rare.

But don’t tell women that critical truth. What would happen to the employment prospects of midwives and doulas if women understood that childbirth has little to nothing to do with mother-infant bonding (as any father or adoptive parent could tell you)? What would happen to the income of lactation consultants if women understood that infant feeding has nothing to do with mother-infant bonding? What would happen to the book sales of attachment parenting experts, if women understood that mother-infant bonding happens spontaneously and there’s no need to read any books or practice specific parenting rituals?

The medicalization of attachment — and the self-surveillance and self-doubts of mothers — benefits the natural parenting industry and that’s why they have promoted it aggressively and relentlessly.

It harms mothers and it harms babies, but let’s be serious: who really cares about them?

Philosophy professor Fiona Woollard has written a fascinating paper on the issue of breastfeeding and maternal duties entitled Is It Okay to Let My Child Be Stung by a Wasp?

New mothers report feeling shamed for not breastfeeding, and constantly having to defend their use of infant formula from strangers on social media or in public places like cafes. Coming at a time when new mothers are extremely vulnerable, such guilt and shame can have devastating consequences…

Something that might help would be if we recognised that the health benefits of breastfeeding give mothers a reason, but not a defeasible duty to breastfeed. Defeasible duties are associated with guilt, blame and requirements to justify our behaviour. If you have a duty to do something then you are required to do it; if you don’t, other things being equal, you should feel guilty and people with appropriate standing can blame you.

Defeasible duty is a technical philosophy term; colloquially we might call it a moral imperative. So the question becomes: do the purported health benefits of breastfeeding lead to a moral imperative for a mother to breastfeed? Woollard believes that the answer is “no” because not all reasons reach the threshold of moral imperatives.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Is there a moral duty to do what is safest for a baby?[/pullquote]

Woollard notes:

We treat mothers and pregnant women as if they have a defeasible duty to perform each action that might benefit their child. That’s why we tend to act as if it follows from the fact that breastfeeding has health benefits that the mother has a defeasible duty to breastfeed. I call this a maximal maternal duty to benefit.

Most lactation professionals claim to believe, and craft their language to promote, the idea of maximal maternal duty to benefit. For them, the fact that breastfeeding has any health benefits is not merely a reason to breastfeed but a moral imperative to breastfeed.

But most of us, including lactation professionals, do not believe in a moral imperative to do anything that benefits a child regardless of other factors. For example, I doubt lactation professionals would claim that there is a moral duty to buy a Volvo, the safest car on the road.

If you do the math, the risk of a child dying in a car accident is far greater than the risk of being “harmed” by formula feeding, regardless of what magical benefits you ascribe to breastfeeding. But wait, you say. Volvos are expensive, many people cannot afford them and they might destroy the family budgets of even those who could scrape together the money. In other words, the benefits to the child can be balanced or even outweighed by the harms to the family. Therefore, while the fact that it is safer might be a reason to buy a Volvo, it does not lead to a moral imperative to buy a Volvo.

In other words, there is not a maximal maternal duty to benefit. Yet if reducing the greater risk of dying in a car accident isn’t a moral imperative, why would breastfeeding be a moral imperative?

The Volvo example is a bit outlandish but there are several situations a lot closer to breastfeeding that pose the same moral conundrum.

Is there a moral imperative to avoid co-sleeping with infants?

There is simply no question that co-sleeping increases the risk of sudden infant death. True, not every breastfeeding pair has the same risk but the risk exists for everyone. In other words, there is a measurable benefit to a baby to sleep outside its mother’s bed. Any theory of a maximal maternal duty to benefit creates a moral imperative for mothers to reject the practice of co-sleeping.

Most lactivists and lactation professionals are appalled at the thought. Co-sleeping makes breastfeeding more convenient, and although they would be the first to lambaste a mother who chose formula because it is more convenient, they rate their own need for convenience in breastfeeding very highly.

Besides, they claim, breastfeeding itself reduces the risk of sudden infant death. So what? If there is a moral imperative to breastfeed because of the health benefits, then surely there is the SAME moral imperative to reject the practice of co-sleeping.

How about homebirth? If a maximal maternal duty to benefit leads to a moral imperative to breastfeed, then the same principle creates a moral imperative to give birth in the hospital.

Homebirth in the US dramatically increases the risk of perinatal death. The best analysis to date, conducted by Judith Rooks, CNM MPH shows that homebirth with a licensed homebirth midwife increases the risk of perinatal death by 800%.

But wait, homebirth advocates say, homebirth provides benefits for the mother. So what? If mothers are morally required to do what is best for babies, regardless of the impact on themselves, then it doesn’t matter how mothers might benefit from homebirth. They have a moral duty to deny themselves those benefits in order to maximize the health and survival benefits to the baby.

Is there a moral imperative to vaccinate?

Every pediatric health organization promotes vaccination even more aggressively than breastfeeding. If they were forced to choose between them, they would undoubtedly choose vaccination as far more beneficial to babies than breastfeeding. Even their absurd claim that higher breastfeeding rates could save more than 800,000 lives per year pales into insignificance compared to the hundreds of millions of lives saved by vaccination.

Anyone who insists that there is a moral imperative to breastfeed because the WHO says it saves lives must acknowledge that there is a greater moral imperative to vaccinate because it saves far more lives. Yet millions of parent insist that what they personally believe about the benefits and risks of vaccination should carry greater weight than WHO recommendations. If that’s the case, then how can there be a moral imperative to breastfeed when many women believe the risks to their babies, themselves and their families outweigh the benefits?

Where does that leave us?

At a minimum, we must acknowledge that we do NOT believe in a maximal maternal duty to benefit. We don’t believe that mothers are obligated to drive Volvos or nothing else. Moreover, many passionate advocates of natural mothering do NOT believe that the fact that co-sleeping, homebirth, and refusal to vaccinate increase the risk of death means that mothers are obligated to avoid co-sleeping, homebirth and vaccine refusal. They recognize and respect that fact that there are other factors (convenience, finances, parental beliefs) that are involved.

Now they just need to recognize and respect that there is more involved with breastfeeding than benefits to babies.