Apparently many conservatives believe that women should be punished for having abortions. I have a better, more just, more effective suggestion:

Punish men for abortions!

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Given their deep commitment to ending abortion, anti-choice politicians should welcome the plan to punish men with imprisonment and fines.[/pullquote]

After all, it’s the man’s fault; there’s no way a woman can find herself with an unwanted pregnancy without a man being responsible for it.

Christina Cauterucci at Slate wrote about the anti-choice beliefs of Trump supporters.

In an online survey, 39 percent of 2,000 self-identified Donald Trump voters reported that they thought women should be punished for seeking abortions if the procedure is ever banned in the U.S. A full 60 percent of those polled said abortion should be illegal; 18 percent of all the poll’s Trump voters said it should be illegal without exceptions for rape, incest, or to save a pregnant woman’s life…

Anti-choicers are enraptured with the notion of punishment for abortion:

Anti-choice legislators pass laws requiring women to listen to state-sponsored misinformation and wait days between requesting an abortion and getting one, revealing a fundamental mistrust of women’s capacity to make their own decisions. Laws in many states make women travel to clinics more than 100 miles away for multiple appointments, separated by days, costing them unnecessary time and money. Restrictions on when women can get abortions force some women to carry to term fetuses with no chance of surviving outside the womb. Women are charged with felonies and incarcerated in the U.S. for trying to induce abortions on their own.

But that’s so inefficient!! Why punish a woman for an unwanted pregnancy when she didn’t want it in the first place? It makes so much more sense to punish the man who made it happen.

Think of the advantages:

It is far simpler: All it takes is a simple paternity test on the products of conception. Quick! Easy! Painless!

It is foolproof: Let’s face it, there are lots of things that women can do to avoid being punished for having an abortion. The biggest problem with state abortion restrictions — requiring unnecessary ultrasounds, forcing women to listen to lies about abortion, or mandating two clinic visits instead of one — is that they can be evaded if a woman travels to another state. But if all she has to do is name the father and bring back the products of conception for testing, we can punish the appropriate man every time!

It is true justice: Women don’t create unwanted pregnancies; men do. Punishing women for having abortions is like punishing women for getting stabbed. Ethics demands that we punish the man who did the stabbing not the victim, right? By the same reasoning, ethics demands that we punish the man who caused the unwanted pregnancy, not the woman who is, in truth, the victim of the unbridled sexual appetites of a man.

It will be much more effective: Women who get pregnant through rape or incest can’t avoid getting pregnant, but the men who commit those crimes could certainly avoid them if they chose. How better to prevent rape and incest in particular, and unwanted pregnancies in general, than holding the perpetrators to account?

How would we punish the men we identify in this way?

A long prison term is the obvious choice, at least ten years at minimum!

On their way to prison they should be forced to walk a public gauntlet of abortion protesters and be subjected to vicious criticism. What’s good for the goose is good for the gander, right?

Beyond that, their names should be published so that everyone they know should witness their shame; a large fine in on release from prison wouldn’t be remiss, either!

I know it sounds harsh, but if we are really committed to ending unwanted pregnancies that result in abortion, this would go a long way toward making men take responsibility for their irresponsible behavior.

To kick off the campaign, I suggest that all male anti-choice politicians, publicly confess to any abortions they have been responsible for in the past and submit their DNA to be used in the event that they cause future unwanted pregnancies.

Anti-choice male politicians should publicly acknowledge their part in unwanted pregnancies (if any), serve the prison time and pay the fines, setting an edifying example in the process.

Given their profound commitment to ending abortion, anti-choice politicians should greet the plan to punish men for abortions with unrestrained enthusiasm.

Of course, if they reject such a plan we’ll be left to conclude that anti-choice politicians don’t want to prevent abortions; they just want to punish women for having sex.

Midwives have a problem with scientific evidence.

It wasn’t always that way.

[M]idwives were initially enthusiastic about basing clinical practice on scientific evidence. That’s because they had long told each other that midwifery was “science based” while obstetrics was not… It has been quite a shock to midwives and childbirth educators to learn that most of their own practices have never been scientifically validated. Even worse, from the point of view of ideology, their critique of modern obstetrics flies in the face of the existing scientific evidence… Thus began the attack on scientific evidence.

I wrote those words almost ten years ago. In the intervening years I have detailed how the problem has only gotten worse. Now a new medical anthropology paper tries to rebut my criticism of modern midwifery’s cavalier dismissal of scientific evidence that doesn’t support their pre-determined conclusions. Ironically, the author ends up substantiating my claims. She demonstrates what I have been writing recently: contemporary midwifery is more religion than science.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Personal experience is evidence, just not scientific evidence; it is religious evidence.[/pullquote]

Andrea Ford of the University of Chicago has written Advocating for evidence in birth: Proving cause, effecting outcomes, and the case for ‘curers’ a forthcoming paper in Medicine Anthropology Theory.

At least two conceptions of ‘evidence’ circulate in current maternity care: it is used in biomedical ‘evidence based obstetrics’ and also by people seeking to reform conventional obstetric practices. Inspired by recent fieldwork in California, this article uses the history and philosophy of science to tease apart implicit differences in what ‘evidence’ is understood to be, distinguishing biomedical evidence based on controlled experiments used to prove cause, from reformist use of evidence foregrounding patient outcomes…

Ford believes I am an avatar for “traditional” biomedical evidence in contrast to midwives who have a “reformist” view of evidence:

The popular blog The Skeptical OB, written by obstetrician Amy Tuteur, is an exaggerated foil … that exemplifies this confrontation. She was notorious among some reformists for her often-vitriolic rhetoric and insistence on the moral corruption of ‘the natural childbirth industry’. Tuteur directly confronts evidence usage in at least fifteen posts, calling the idea that obstetrics is not evidence based a ‘smear campaign’… She calls reformist [midwifery theorists] usage of evidence a double standard, in which evidence is embraced when it aligns with prior ideological commitments (or profits) but dismissed when it doesn’t.

Kudos to Ford for accurately representing my views rather than caricaturing them. Unfortunately, she’s far less successful when she attempts to rebut them.

Tuteur is attempting to arbitrate which ‘side’ is using evidence correctly, which is quite different from my objective in considering its rhetorical and practical function as a boundary object that can be claimed by people with different aims and assumptions, enabling people to feel like they are speaking the same language even without consensus.

But I’m not trying to arbitrate who is using evidence correctly. I am simply noting that obstetricians use scientific evidence, while midwives are reduced to pretending beliefs are scientific evidence. Of course Ford cannot admit that; she prefers to claim that midwives seek to replace “proving” with “curing.”

In my fieldwork, reformists [midwifery theorists] seemed generally enthusiastic to explain why particular outcomes occurred, but they do not attempt to prove why scientifically — that is, experimentally. I found narrations of causality to be common; for example, that nipple stimulation releases oxytocin and oxytocin causes contractions, therefore nipple stimulation will effect the onset of labor.

Such explanations are not arbitrary personal claims (‘anecdata’, as one disparaging commenter on one of Tuteur’s evidence posts phrased it), but neither are they objectively-randomized quantitative proofs. They are rational, not experimental. Controlled trials, by contrast, are experiments, seeking to prove cause by eliminating all but one potentially-causal factor, and randomization is the closest approximation to researcher objectivity, so RCTs are the ‘gold standard’ for trustworthy experience.

For Ford, it doesn’t matter whether nipple stimulation can be proven to induce labor so long as the midwife and patient believe it can. In this way, midwifery theorists can assert with a straight face that what the patient believes has happened is “scientific evidence” on an equal footing with objective evidence of what has actually happened.

…[R]eformist activism [midwifery theory] has redirected the focus of ‘good research’ onto outcomes prioritizing the patient’s perspective …. seeking empirically good outcomes no matter their rationale …

Ford imagines that I and other obstetricians fear substituting objective evidence with belief. She references philosopher Isabelle Stengers:

She warns that if proof and cure are independently valued and sought, doctors will cry out for some way to identify charlatans so medicine is not just arbitrary — in this case, practicable by lay midwives, citizen scientists, intuitive mothers, a nurse with a website. Tuteur’s blog, The Skeptical OB, falls in line with this prediction.

Medicine should “lose the fiction” that …

the suffering body ‘should’ be able to tell the difference between real medicine and fake — for example, between labor induced by an intravenous drip of pitocin, and that which coincides with nipple stimulation, eating spicy food, and walking up stairs, all of which are non-medical techniques to influence labor’s onset …

Ford misunderstands my objection.

Personal experience is evidence, just not scientific evidence. Personal experience is religious evidence. It is a variation on the argument from religious experience.

The argument from religious experience is the argument from experiences of God to the existence of God. In its strong form, this argument asserts that it is only possible to experience that which exists, and so that the phenomenon of religious experience demonstrates the existence of God. People experience God, therefore there must be a God …

Ford’s midwifery version could be articulated as follows:

It is only possible to experience that which exists so if a patient or midwife “experiences” a labor being induced by nipple stimulation or spicy food, that demonstrates that nipple stimulation and spicy food must be a forms of labor induction.

Viewing “evidence” in this way speaks to the fact that midwifery has become more religion than science.

As I wrote just last week: Consider midwives like Sheena Byrom and Hannah Dahlen. They “believe in” the superiority of unmedicated vaginal birth. Their “belief in” the power and perfection of natural childbirth exists prior to and independent of scientific fact. It is both immutable and non falsifiable.

Ford would have us conclude that the fact that Byrom and Dahlen (and some of their patients) believe unmedicated vaginal birth is superior is proof that it is superior in exactly the same way that religious experience is “proof” that God exists.

This ‘personal care’ reflects an orientation around the birthing person’s perspective, which is the fundamental difference between curing and proving.

But it’s not the difference between curing and proving; it’s the difference between religious belief and scientific evidence.

The ultimate irony is that while Ford thinks she is rebutting my criticism of modern midwifery, she is both corroborating and bolstering it.

Even as his 11 year old daughter lay dying, he refused to seek medical care:

Prosecutors contended he should have rushed the girl to a hospital because she couldn’t walk, talk, eat or drink. Instead, Madeline died on the floor of the family’s rural home as people surrounded her and prayed.

It wasn’t until Dale Neumann’s daughter stopped breathing that they called an ambulance.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Every day a hundred babies are admitted to the hospital for dehydration and starvation because of a near religious faith in breastfeeding.[/pullquote]

Neumann was convicted for murder in the easily preventable death of the girl from diabetes. Neumann freely admitted that he put faith in God before medical care.

Neumann, who once studied to be a Pentecostal minister, testified on Thursday that he believed God would heal his daughter and he never expected her to die. God promises in the Bible to heal, he said.

“If I go to the doctor, I am putting the doctor before God,” Neumann testified. “I am not believing what he said he would do.”

Most of us read stories like these convinced that we would never sacrifice a child on the altar of religious faith. Yet every day a hundred babies are admitted to the hospital for dehydration and starvation because of a near religious faith in breastfeeding.

Yesterday a popular Facebook page, Breastfeeding Mama Talk, posted this horror playing out in real time, implying there was more than one reasonable choice.

I need advice please mommas. I just had my last baby. He will be one month on the 19th. He is my fifth…
-My little man was born weighing 7.1 pounds…
-But at his 2 week check up he lost weight and weighed 6.10. The dr told me I had to switch to formula. I said not yet…
-They had us back a week later (today) to weigh him. He’s only gained one ounce, 6.11.
The Dr is really pushing formula now. He is saying my baby is malnourished and not getting enough calories for sufficient brain development.

I know he’s watching [? nursing] fine and I’m making plenty of milk. I don’t understand why he isn’t gaining the weight. I’ve been crying all day. I feel like it’s still so early to just say, “Switch to formula!”, but I don’t want to be starving my baby. I don’t know what to do…

The doctor sent the mother home with this note:

Baby is malnourished — he should be at birthweight by 2 weeks of age. He is not getting enough calories to promote brain growth. Please supplement with formula every 3-4 hours.

Let’s leave aside for the moment the fact that the doctor is not asking her to switch to formula but to supplement with formula. The doctor is literally begging the mother to feed the baby before he suffers brain damage or dies… The mother claims she doesn’t know what to do.

Why is she hesitating? Because breastfeeding has become her religion. As I wrote recently, natural mothering advocates surrender personal agency in the same way they do in religious fundamentalism.

Rather than “Let go. Let God.”, lactivists encourage each other to “Let go. Let Breastfeeding.” The attributes of God are ascribed to Nature. It is perfect, all powerful and infinitely adaptable. It literally cannot fail.

The faith healing father viewed his daughter’s diabetes as a crisis of his faith in God. He believed that if he maintained his faith, God would cure his daughter’s diabetes. This mother appears to view her son’s starvation as a crisis of her faith in breastfeeding. She still believes that if she maintains her faith, breastfeeding will cure her son’s malnutrition.

Make no mistake, her son is literally starving, possibly to death. Beyond the first few days, an infant should NEVER lose weight. Weight loss means a baby is cannibalizing his own body in order to keep vital organs supplied with glucose so the cells of those organs can survive.

Babies’ brains grow fastest in their first year; who would risk even the slightest chance that his or her brain is being deprived of the fuel it needs to grow? Those who have a near religious faith in breastfeeding.

By posting to a breastfeeding Facebook page, she is consulting her community of faith; only those who define themselves by their complete and utter trust in breastfeeding can possibly understand the anguish she faces in potentially betraying her deepest beliefs.

How did we get to this terrible place where mothers are compromising their babies’ brains and lives for no better reason than to be able to claim they breastfed “exclusively”? How did we get to the point where a hundred babies are being admitted to the hospital each day for dehydration and starvation even though the treatment — formula — is close at hand? Why is exclusive breastfeeding the LEADING cause for newborn hospital readmission?

We got here because lactation professionals, the priestesses of breastfeeding, have lied and continue to lie about the limited benefits. They have lied and continue to lie about the risks of breastfeeding. They have used public funds and manipulated hospitals and doctors to promote a near religious faith in breastfeeding.

Lactation professionals believe in the perfection of breastfeeding every bit as much as Mr. Neumann believed prayer would cure his daughter’s diabetes. And they are every bit as wrong — DEAD wrong.

We prosecuted Mr. Neumann for letting his daughter die. He has the right to believe whatever he wants, but no right to sacrifice his child’s life for his belief. Similarly, lactation professionals have the right to believe whatever they want to believe, but no right to sacrifice our children’s lives and brain function to demonstrate fealty to their beliefs.

Enough is enough! How many babies have to starve before we relinquish our medically inappropriate, near religious faith in breastfeeding? In truth even one baby harmed is one too many!

Imagine if I told you that tens of thousands of babies were being hospitalized each year for a common problem and yet we weren’t merely doing nothing about it; we were actively promoting more harm. You’d be outraged, wouldn’t you?

Prepare to be outraged.

Tens of thousands of babies are being hospitalized each year, some sustaining permanent brain damage, and a few even dying, because of a common problem — insufficient breastmilk. We aren’t merely doing nothing about it; lactation professionals are actively promoting more harm by lying about the existence of the problem, its frequency, its diagnosis and its prevention.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The most reliable sign of neonatal dehydration is weight loss, NOT wet diapers.[/pullquote]

A new paper, Neonatal Hypernatremic Dehydration, should cause soul searching and policy changes among lactation professionals everywhere. I’m not holding my breath.

It should also give pediatricians and obstetricians renewed impetus to push the deadly Baby Friendly Hospital Initiative out of hospitals. I have far more hope that they will do the right thing and put scientific evidence ahead of ideology.

The paper demonstrates yet again how so much of what passes for “knowledge” among lactation professionals is actually lies.

1. Insufficient breastmilk is common.

Dehydration/excessive weight loss is defined as a loss of more than 10% of birth weight prior to the end of the first week of life, and is thought to occur in up to 15% of exclusively breast-fed infants.

Lactation professionals owe the Fed Is Best Foundation a deep and profound apology. The Foundation was created to highlight both the frequency and the dangers of insufficient breastmilk. Founders Christie del Castillo-Hegyi, MD and Jody Seagrave Daly, RN, IBCLC recognized years ago — through bitter personal and professional experience respectively — that lactation professionals were lying to themselves and each other about the dimensions and harms of the problem. Yet rather than receiving the thanks of the lactation profession, they have been defamed and demeaned by the very people who were causing all the harm.

2. The incidence of clinical neonatal dehydration is high.

Up to one-third of these infants will also be hypernatremic, and the reported incidence of hypernatremic dehydration in term neonates requiring admission ranges from 1% to 5%, with higher rates reported in developing countries.

Despite published statistics, the true incidence of hypernatremic dehydration is difficult to define, as some retrospective studies have included only term neonates, whereas others have included late preterm (>35 weeks gestation) neonates. None have included neonates with predispositions to feeding problems, such as cleft palate, Trisomy 21, neurodevelopmental, or craniofacial disorders.

3. The consequences of neonatal dehydration can be devastating.

Serum sodium level greater than 160 mEq/L is a risk factor for morbidity and mortality. The most commonly cited complications include seizures, bradycardia, vascular thrombosis, disseminated intravascular coagulation, renal failure, intracranial hemorrhage, pontine myelinosis, cerebral edema, and death. Seizure is the most common complication and usually occurs during correction of the hypernatremia, as do the other common complications.

4. Neonatal appearance and the number of wet diapers are NOT reliable indicators of dehydration.

Hypernatremia results in hypertonic intravascular contents, which causes fluid shifts from the cells to the intra-vascular space. Thus, the neonate may appear less hemodynamically compromised, resulting in underestimation of the degree of dehydration by as much as 5%. This also increases the chances an affected infant will present late for medical care.

It’s hard to over-emphasize the importance of this point.

As with many serious neonatal conditions, newborns can look fine right up until the moment they collapse; they have compensatory mechanisms that work until they fail abruptly and completely. In the case of dehydration, infants compensate for the low blood volume caused by dehydration by pulling water out of cells into the bloodstream. As a result, they can keep perfusing their kidneys — and keep urinating — even as they may be dying.

Many lactation professionals and lactivists owe both Jillian Johnson and Christie del Castillo-Hegyi deep and profound apologies for publicly doubting that their babies were dehydrated and for blaming medical staff for failing to recognize the “signs” of dehydration. If you wait to diagnose dehydration until a baby is no longer urinating frequently, you could easily wait past the point of brain damage to the point of death.

5. The most reliable sign of dehydration is weight loss.

Mild hypernatremia should not be considered a benign occurrence, and breast-fed infants with greater than 7% weight loss or significant jaundice should be evaluated for hypernatremic dehydration and the possible need for oral or parenteral fluid supplementation.

This is precisely what the Fed Is Best Foundation has been saying for years. As a result they’ve been vilified by the lactation professionals who are still lying to themselves and each other about the depth and breadth of the problem.

Though this paper doesn’t mention it, lactation professionals have compounded the problem and raised the risk by banning formula supplementation. Multiple scientific papers have shown that judicious formula supplementation is not merely compatible to subsequent exclusive breastfeeding, it actually improves the rate of subsequent exclusive breastfeeding. Moreover, it dramatically decreases the risk of newborn hospital readmission. Infants allowed unrestricted access to formula had a 76% lower incidence of hospitalization.

This new paper on neonatal dehydration illustrates three critical points.

First, the lactation profession as based on ideology, not science. It was ideology that led lactation professionals to claim that breastfeeding, uniquely among all bodily processes, was perfect. Science always showed the opposite.

Second, while the benefits of breastfeeding term babies range from theoretically possible to completely non-existent (no one has yet been able to show a single term baby whose life has been saved by breastfeeding), the risks are very real with literally tens of thousands of babies suffering so much that they must be readmitted to the hospital for treatment.

Third, the public discussion of breastfeeding has been controlled by lactivists to the detriment of babies and mothers. Type “breastfeeding” into Google each and every day as I do to see the latest articles and you will find a myriad of pieces bemoaning the “horror” of some woman somewhere being shamed for public breastfeeding. Yet there is rarely if ever any article in the mainstream media about the dangers of insufficient breastmilk, a problems that is affecting more than 1% of exclusively breastfeeding newborns DAILY.

There is one very obvious thing to do if we wish to help these babies and mothers, prevent tens of thousands of hospitalization a year and dramatically reduce the risk of permanent brain damage or death: allow new mothers unrestricted access to infant formula. If we care about babies, we will do it. If we only care about breastfeeding, we will continue to let babies suffer.

There is also one less obvious thing to do: eject the Baby Friendly Hospital Initiative from hospitals. There is no place in any hospital for an organization whose primary commitment is to its own ideology instead of to patients. It has indisputably harmed hundreds of thousands of babies and mothers. It’s time to end the harm.

On Friday I asked if natural mothering is really a religion, albeit one that replaces God with Nature.

I wrote about two features common to the stories natural mothering advocates tell about themselves, conversion experiences and submission to a higher power.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]For natural mothering advocates, belief in the perfection of Nature is a matter of faith, not reason.[/pullquote]

How to they know that what they believe is true? The same way religious believers know: they “feel it.”

As Chris Bobel notes in The Paradox of Natural Mothering:

It is clear that the reasons for natural mothering are often literally beyond reason. Rather than being rooted in an epistemology derived from the intellect, this type of “knowing” is intuitive, even instinctual and therefore defies explanation, the natural mothers imply. Decisions are not ultimately based on thinking, but on feeling.

Scholars of religion might refer to the distinction as “belief in” vs. “belief that.”

Epistemologists have not usually had much to say about believing ‘in’, though ever since Plato’s time they have been interested in believing ‘that’. Students of religion, on the other hand, have been greatly concerned with belief ‘in’, and many of them, I think, would maintain that it is something quite different from belief ‘that’… On this view belief ‘in’ is not a propositional attitude at all.

To put it simply, “belief in” is a matter of faith; “belief that” is a matter of intellect.

This distinction is critical when attempting to understand the behavior of advocates, professional and lay, of natural childbirth and breastfeeding.

Consider midwives like Sheena Byrom and Hannah Dahlen. They “believe in” the superiority of unmedicated vaginal birth. They — like creationists — might marshal what sound like scientific facts to justify their belief and to try to convert others, but the “belief in” the power and perfection of natural childbirth exists prior to and independent of scientific fact. And, like belief in creationism, it is both immutable and non falsifiable.

Why? Because they “feel” it to be true. It is a matter of faith, not reason.

Consider professional lactivists like Amy Brown, PhD and Melissa Bartick, MD. They “believe in” the superiority of breastfeeding. They — like creationists — might marshal what sound like scientific facts to justify their belief and to try to convert others, but the “belief in” the power and perfection of breastfeeding exists prior to and independent of scientific fact. And, like belief in creationism, it is both immutable and non-falsifiable.

Why? Because they “feel” it to be true. It is a matter of faith, not reason.

Both natural childbirth and breastfeeding advocates recognize the distinction; hence the veneration of “intuition” over reason. What is intuition except a form of belief that is independent of reason?

The similarities with religion don’t end there. Like many faith based believers, natural childbirth and breastfeeding advocates feel compelled to proselytize. They’ve heard the “good news” and want to share it with everyone else.

They don’t call it proselytizing, though, they call it “normalizing.”

The natural childbirth advocates who want to “normalize” unmedicated vaginal birth don’t merely want to make it acceptable or even common; they want to make it normative. Lactivists who want to “normalize” breastfeeding don’t merely want to make it acceptable or even common; they want to make it normative. Like supporters of theocracies, ideally they want to forge true believers, but they will settle for forcing others to behave like true believers.

Why? Because unbelievers are headed for Hell.

Not the literal afterlife Hell of religious believers, although quite a few natural childbirth and breastfeeding advocates seem convinced that those who choose C-section on maternal request or formula feeding are destined for Hell. Natural mothering hell is a hell on earth made manifest by a baby that doesn’t bond, is stupid, obese, and suffers from immune disorders or — worst of all — autism, the natural mothering equivalent of leprosy.

The world is divided into communities of believers and unbelievers and unbelievers do not merit even basic human kindness. There is no limit to the mental cruelty believers feel entitle to inflict on those who refuse to mirror their beliefs.

I came across this gem yesterday, on Mother’s Day:

If you didn’t breastfeed you don’t deserve to celebrate Mother’s Day.

In what lactivists probably imagine as benevolence, they’ve appended an asterisk.

*Legitimate medical reasons excluded.

No doubt they’ll decide whether your reasons are legitimate reasons.

It’s a powerful illustration that natural mothering is not science; it’s religious faith.

That’s fine! Natural childbirth and breastfeeding proponents are entitled to believe whatever they want to believe.

And the rest of us are entitled to raise our children based on what the scientific evidence shows, not the self-serving, quasi-religious beliefs of natural mothering advocates.

Whether it’s childbirth, breastfeeding or postpartum depression and anxiety, for the past three decades we have been harming mothers grievously by pretending that ideology is science.

For three decades we’ve obsessing over C-section rates, induction rates and interventions rates.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Natural childbirth and breastfeeding advocates have demonstrated a curious lack of concern for the impact of their ideologies on women themselves.[/pullquote]

Meanwhile C-sections weren’t harming women and actually cost less than vaginal births. Routine induction at 39 weeks saves lives. But most importantly, women have been dying for LACK of interventions.

For three decades we’ve been obsessing over breastfeeding rates claiming that breastfeeding could save hundreds of thousands of lives.

Meanwhile, no one could ever show that any health parameter for term babies was improved by increased breastfeeding rates, tens of thousands of babies were being readmitted to the hospital each year for dehydration and jaundice, and many babies were deprived of the lower risk of SDIS (as well as the soothing) associated with pacifiers.

For three decades we have been prattling about birth “experiences” and “normalizing” breastfeeding.

Meanwhile countless women were suffering postpartum experiences blighted by depression and anxiety and others were suffering the horror of having starved their own babies in an effort to breastfeed.

We have no indication that mothers are doing better today than they were before we embarked on our well-meaning efforts and some reason to believe that they are doing worse.

What went wrong?

We embraced natural childbirth and lactivist ideology and pretended it was science.

We owe mothers an apology and there’s plenty of blame to go around. Ideologues should be first in line to apologize.

And as epidemiologist and founding member of the Cochrane Collaborative Hilda Bastian wrote recently:

…[T]he main thing I learned – very painfully – in 20 years as a health consumer advocate, is that zealots always, always end up hurting patients. Because whatever it is that they are against, is not the same as being for patients, and it will, inevitably, betray us.

Midwives (particularly in the UK and Australia), doulas and childbirth educators are often zealots who value ideological purity above the well being of women. They oppose technological birth, doctors and insitutions that curtail their autonomy … but that’s NOT the same as being for women.

Like most zealots, they believe one size fits all: unmedicated vaginal birth is best in all but “rare” cases.

For the past three decades, while midwives, doulas and childbirth educators have blithered endlessly about promoting “physiological birth” as well as the evils of C-sections, inductions and other inventions, not a single parameter of women’s health has been improved as a result. Women have continued suffer severe morbidity and to die in and around childbirth because of lack of access to the same high tech care that natural childbirth advocates are bewailing. Worse, they may have begun to die in higher numbers in the US because providers have been bewitched by the lie that childbirth is inherently safe when in truth it is inherently dangerous.

Lactivists and most lactation professionals are zealots. They have an almost visceral hatred of formula companies and are opposed to formula … but that’s NOT the same as being for babies or women.

Like most zealots, they believe one size fits all: breastfeeding is best in all but “rare” cases. They make the bizarre claim that breastfeeding is perfect when there is NO bodily function that is perfect.

They’ve insisted that aggressive breastfeeding promotion is based on science, while forgetting that they instituted the Ten Steps of the Baby Friendly Hospital Initiative without ANY scientific evidence at all. It was ten years before they even began doing the necessary research and at that point they were trying to justify what they had already mandated.

As a result, they grasped at any data that seemed to show breastfeeding as beneficial, but didn’t bother to correct for the confounding socio-economic and educational variables that are known to be associated with breastfeeding. As a result, tens of thousands of babies and mothers are harmed each and every year by policies that never had any basis in science even though they were being touted as supported by science.

The toll of lactivist ideology is only just being appreciated because pediatricians became horrified by its harmful effects. The highest quality studies — studies that DO correct for confounding variables — have found that most of the purported benefits of breastfeeding are illusory.

The 2018 paper Is the “breast is best” mantra an oversimplification? summarizes the evidence that the benefits have been overstated and the risks ignored.

The evidence for infant breastfeeding status and its association with health outcomes faces significant limitations; the great majority of those limitations tend to overestimate the benefits of breastfeeding. Nearly all evidence is based on observational studies, in which causality cannot be determined and self-selection bias, recall bias, and residual confounding limit the value or strength of the findings.

And aggressive breastfeeding promotion has very real harms:

…[E]xclusive breastfeeding at discharge from the hospital is likely the single greatest risk factor for hospital readmission in newborns. Term infants who are exclusively breastfed are more likely to be hospitalized compared to formula-fed or mixed-fed infants, due to hyperbilirubinemia, dehydration, hyper- natremia, and weight loss (number needed to harm (NNH)=71). For weight loss >10% of birth weight with or without hospitalization, the NNH for breastfed infants is 13.

Throughout the relentless promotion of natural childbirth and breastfeeding ideologies as science, its advocates have demonstrated a curious lack of concern for the impact of these ideologies on women themselves. We are in the midst of what feels like an epidemic of postpartum depression and anxiety and not only do childbirth and breastfeeding ideologues fail to question their own role in promoting women’s distress, they insist on doubling down on the very tactics that women often identify as the source of their distress — shame and humiliation at not having an unmedicated vaginal birth and struggles to breastfeed.

All providers have an ethical obligation to provide women with informed consent and informed consent can only be given when women have access to ACCURATE scientific evidence, risks as well as benefits; ideology is not a substitute.

All providers have an ethical obligation to RESPECT the choices of informed mothers; it is paternalism to imagine that providers know better than women what is best for themselves. Claims — beloved of natural childbirth and breastfeeding ideologues — that women need more “education” and “support” to make the decisions that providers favor is just another form of paternalism.

Most importantly, natural childbirth and breastfeeding advocates must start taking women’s MENTAL HEALTH into account in their calculations about risks and benefits.

Natural childbirth and breastfeeding advocates have been proven wrong over and over and over again. Countless women have been harmed as a result. On this Mother’s Day, ideologues owe them an apology.

Natural mothering is a cultural pre-occupation of both the Right and the Left.

Consider the lifestyle of fundamentalist mothers: every moment of the day consumed with child and family care. From homebirth to homeschooling, from growing her own food to baking her own bread, from extended breastfeeding to rejection of conventional medical care, women are trapped in their own homes by a never ending series of labor intensive tasks. Above all, they are indoctrinated to ignore their own needs in favor of other family members.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Both feature conversion experiences, trust in and submission to a higher power, a fervor for proselytizing and condemnation of those who make different choices.[/perfectpullquote]

Consider the lifestyle of a radical natural mothering advocate: every moment of the day consumed with child and family care. From homebirth to homeschooling, from growing her own food to baking her own bread, from extended breastfeeding to rejection of conventional medical care, women are trapped in their own homes by a never ending series of labor intensive tasks. Above all, they are indoctrinated to ignore their own needs in favor of other family members.

But it’s more than just the superficial similarities. Natural mothering seems to share major philosophical features including conversion experiences, trust in and submission to a higher power, a fervor for proselytizing and condemnation of those who make different choices.

The only difference is that natural mothering advocates on the Right believe they are mandated by God to adopt the lifestyle, whereas natural mothering advocates on the Left believe they are mandated by “Nature” to do so.

Is natural mothering a religion?

I’m not the first person to notice the remarkable similarities, both superficial and deep.

Chris Bobel, in The Paradox of Natural Mothering, describes the centrality of conversion experiences, which she calls shock-shift stories:

These stories unfolded predictably. Soon after the birth of her first child, the new mother was shocked by her overwhelming feelings of love for her baby and her companion feelings of being unable to leave him or her. Next, she shifted her perspective from that of a pregnant woman with careerist aspirations to that of a new mother who simply had to be with her baby around the clock. For her, there was no alternative, no choice.

Women surrender personal agency in the same way they do in religious fundamentalism. Rather than “Let go. Let God.”, natural mothering advocates encourage each other to “Let go. Let Nature.”

Describing the views of one mother, Bobel notes:

[Her] conceptualization assumes that women must willingly submit to biology’s shaping of their lives… [I]ts centrality in natural mothering undermines the mother’s claim of personal agency and free will as the impetus for her lifestyle. Natural mothering, it appears, is less a lifestyle fashioned by individual women making hard choices about the best way to parent than a chosen lifestyle represented in essentialist terms.

Bobel explains how natural mothering advocates like to think about themselves:

If we listen to their narratives of self-motivated decisions to quit jobs and careers and stay at home full-time with babies, we see strong, self-determined women who actively choose a particular lifestyle, even if that lifestyle denies the individual mother’s self-actualization.

But, in truth:

Natural mothers … may actively choose to embrace the “nature is best” ideology, but once they become attached to this ideology  –  buying into it completely and without regret  –  they surrender their capacity to make choices and in some ways become passive objects. Put differently, the ideology begins to take on hegemonic proportions and transforms women into individuals who surrender their own agency in the interest of family.

What they initially describe to themselves and others as a “choice,” comes to seem like no choice:

…[N]atural mothers claim that they could certainly choose to parent like “everyone else” (i.e., like the majority of conventional, mainstream mothers), but at the same time they speak of choice, they speak of being guided by an intuitive, body-derived source of knowledge, one that is undeniable, one that they can never dispute or reject… Natural mothering is the only real choice. The natural mothers in this study were adamant that they cannot turn their backs on the natural ideology so central to their way of living, sleeping, eating, schooling, and consuming.

They’ve surrendered their agency to a “higher power.”

It might be an overstatement to claim that the natural mothers have replaced God or Man as the authority that dictates a life course with nature as represented by the body, but perhaps not. Whether the mothers are controlled by men or religion or some conception of nature, they are still controlled.

They live their lives according to a script, whether that script is religious or based on the worship of nature.

…[C]onstructing a lifestyle on the basis of a body-derived feeling that can neither be explained nor denied is the action not of an agent, but of an individual who is dutifully following a script. In this case the script was written by biologically determinist and historically gendered ideas about women, mothers, and families.

Because — and this is the critical point — our ideas about “Nature” are cultural constructs.

When the mothers spoke of nature, they spoke of a monolithic and static concept, the one true thing that predates dates humankind and remains pure and unadulterated. To them, nature is the perfect model for human behavior because it is separate from and unpolluted by human manipulation. This view, of course, is problematic; it denies the many ways in which nature is indeed culturally constructed …

The way that ancient peoples viewed nature is very different from the way that scientists view nature, for example. The views of ancient peoples are every bit as cultural determined (it was their religion!) as the views of scientists and neither is a completely accurate assessment of nature itself. Natural mothering advocates have simply traded the religion of the present for the biologically determined, gendered and often misogynist religion of the past.

Natural mothering advocates believe, like many ancient peoples believed, that Nature is an irresistible higher power that should be worshipped: venerated, trusted and to which we must submit.

That’s not reasoning or choice; it’s religious fundamentalism.

There has been a spate of articles purporting to explain what Meghan, Duchess of Sussex is trying to “tell us” with her choices.

The subtle but important message Duchess Meghan is sending new moms about giving birth:

Meghan showed the world something that many of her royal predecessors have covered up: what a woman’s body looks like a mere 48 hours after birth. Her simple and understated white dress did not hide what her body had gone through. A simple belt tied high above her waist, in fact, seemed to be an intentional signal.

It was as if she was saying to the world, “Hey, I told you you’d have to wait a couple of days before you could see me, and this is what I look like. This is what happens to a woman’s body, even a woman like me who made a career out of rockin’ the pencil skirts on ‘Suits.’ ”

The belief that Meghan, Duchess of Sussex is trying to tell us something is symptomatic of our dysfunctional mothering culture that insists that the personal must be political. No longer can a mother make a choice simply because its the right thing for her baby and herself. We imagine her, and insist she must imagine herself, as sending messages about how to perform mothering.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]But what if the “message” Meghan is trying to send is that she is not going to be trapped by a culture that insists she must send messages? [/pullquote]

Mothering is no longer an intricate, intimate, largely private physical and emotional dance of baby and mother. It is assumed to be a highly stylized dancing performance created for the delectation of other women who seek to parse its “meaning.”

But what if the “message” Meghan is trying to send is that she is not going to be trapped by a culture that insists she must send messages with her choices?

What if she desired a homebirth because she feared being victimized by a hoax like that played on the hospital staff during her sister-in-law’s first pregnancy?

What if she postponed her first postpartum photo-call because she couldn’t stand unaided until then?

What if she chose that particular dress to wear because her first choice had been ruined by blood flow that couldn’t be contained by the multiple pads and net panties that were almost certainly underneath and her second choice promptly got stained by milk when she let down after hearing her baby cry?

What if she makes choices simply because they seem to her to be the best choices for baby and herself, and she has absolutely no interest is the choices that other mothers make?

What if the personal is just personal and NOT political?

We live in a mothering culture that is constantly trying to force mothers to behave in predetermined ways. We are every bit as rigid in our sanctimonious prescriptions for unmedicated vaginal birth, breastfeeding and baby-wearing as previous generations were in their prescriptions for twilight sleep, formula feeding and limited mother-infant contact designed to avoid “spoiling” babies. But whereas they were honest with themselves, we fool ourselves by insisting that we aren’t pressuring women, we are “normalizing” natural behaviors.

Feel free to correct me, but I’m not aware of a single health parameter or mental health parameter that has been improved by switching from an rigid insistence on one type of mothering to a rigid insistence on its “natural” opposite. It’s as if the various processes doesn’t matter — because they don’t.

Mothers should make choices for their children because — knowing their children and themselves best — they think those are the best choices. They should not make choices for their children that are designed primarily to impress other mothers.

They should not fool themselves into thinking that their own choices ought to be “normalized” for the edification of everyone else.

And women should not imagine that other mother’s choices are a commentary on their choices and need to be praised or resisted. Other women, including the Duchess of Sussex, are not trying to send them messages; they’re just trying to do what feels right.

The fact that we think otherwise is symptomatic of our dysfunctional mothering culture.

While the critics of modern obstetrics have been dithering about C-sections and intervention rates, American women have been dying in and around childbirth of potentially preventable causes that have nothing to do with either.

The latest CDC report on maternal mortality confirms that the US maternal mortality rate is high NOT because of C-sections and interventions, but because women haven’t received the lifesaving interventions they’ve needed.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Modern obstetrics has taught us how to prevent many maternal deaths. We just need to do it.[/pullquote]

According to the Washington Post:

The CDC confirmed in a report released Tuesday that about 700 women die each year in the United States from cardiovascular conditions, infections, hemorrhages and other complications related to their pregnancies — up to a year after delivering their babies. In about 60 percent of the cases, the deaths could have been prevented, in part, with proper medical intervention, as well as better access to it, the researchers noted.

The report itself is short and worth reading in full. This paragraph includes the most important findings:

Pregnancy-related deaths occur not only during delivery but also during pregnancy and up to 1 year postpartum. The leading causes of pregnancy-related deaths varied by timing of death. Acute obstetric emergencies such as hemorrhage and amniotic fluid embolism most commonly occurred on the day of delivery, whereas deaths caused by hypertensive disorders of pregnancy and thrombotic pulmonary embolism most commonly occurred 0–6 days postpartum, and during pregnancy and 1–42 days postpartum, respectively. Cardiomyopathy was the most common cause of death in the late postpartum period (43–365 days postpartum). The higher proportion of pregnancy-related deaths in the late postpartum period among black women is likely attributable to higher proportion of pregnancy-related deaths due to cardiomyopathy among these women. Approximately three in five pregnancy-related deaths were determined by MMRCs to be preventable, and preventability did not differ significantly by race/ethnicity or timing of death. Recognizing the major causes of death by timing can help identify opportunities for intervention.

The word “Cesarean” doesn’t even appear in the body of the report and intervention rates are mentioned only to lament that women die for lack of them.

How did we get things so wrong?

We allowed ideology to replace science, specifically the ideology of natural childbirth. The principles of natural childbirth ideology — childbirth is inherently safe, interventions are dangerous and rarely needed, birth should be trusted and allowed to unfold naturally — are fundamentally at odds with reality: childbirth is inherently dangerous, interventions save lives and lots of women die when you allow childbirth to unfold naturally.

The biggest problem, in my view, is a low index of suspicion for complications of childbirth when we should have a high index of suspicion. You can’t diagnose a complication if you’ve been taught that complications are rare and doing nothing is the best response. When providers falsely believe that pregnancy is inherently safe when in reality it is inherently dangerous, nurses and even some doctors will insist that everything is fine even while a woman is dying before their eyes.

Here’s what I proposed back in 2017:

• We must increase access to high tech medical and obstetrical care.
• We must create a system of maternal critical care triage to parallel the highly effective system of neonatal critical care triage.
• We must create algorithms and hold drills to prevent and treat common causes of maternal death.
• We must devote significantly more research dollars to understanding cardiac complications of pregnancy.

This 2017 article by Tara Haelle in Consumer Reports recommended almost exactly the opposite. Titled What to Reject When You’re Expecting, it is paradigmatic of how an ideology that primarily benefits natural childbirth professionals led us to ignore and withhold the very treatments that could have saved lives.

Haelle wrote:

Infants in this country are more than twice as likely to die before their first birthday as those in Japan and Finland, and America lags behind nearly every other industrialized nation in preventing mothers from dying due to pregnancy or childbirth. The U.S. is one of only a handful of countries in the world, including Afghanistan and South Africa, whose maternal mortality rate is rising.

Why? There are no doubt many causes. But one likely contributor may be that medical expediency often takes priority over the best outcomes and evidence-based treatments.

She encouraged women to reject C-sections, repeat C-sections, inductions and delivery prior to term. Haelle was hardly alone in that view. But that was ideology NOT science. They were never implicated in infant and maternal mortality; they SAVE lives.

Here’s what the CDC now recommends:

No single intervention is sufficient; reducing pregnancy-related deaths requires reviewing and learning from each death, improving women’s health, and reducing social inequities across the life span, as well as ensuring quality care for pregnant and postpartum women. Throughout the preconception, pregnancy, and postpartum periods, providers and patients can work together to optimally manage chronic health conditions. Standardized approaches to addressing obstetric emergencies can be implemented in all hospitals that provide delivery services. The Alliance for Innovation on Maternal Health (AIM) has provided sets of bundled guidance to provide for such standardization.

Implementation of this guidance is often supported by perinatal quality collaboratives, state-based initiatives that aim to improve the quality of care for mothers and infants. Ensuring that pregnant women at high risk for complications receive care in facilities prepared to provide the required level of specialized care also can improve outcomes; professional organizations have developed criteria for recommended levels of maternal care. CDC has created the Levels of Care Assessment Tool for public health decision makers to evaluate risk-appropriate care. In the postpartum period, follow-up care is critical for all women, particularly those with chronic medical conditions and complications of pregnancy (e.g., hypertensive disorders of pregnancy). ACOG recommends that postpartum women have contact with obstetric providers within the first 3 weeks postpartum and recognizes postpartum care as an ongoing process tailored to each woman’s individual needs.

In other words, more high tech care, greater access to high tech care, mandated emergency protocols and more provider visits.

We must learn from our mistakes. While gallons of ink were being spilled on the obsessions of natural childbirth ideologues — the C-section rate, the induction rate, epidurals and electronic fetal monitoring — we were ignoring the deadly problems that are literally killing new mothers: cardiac disease in pregnancy, pre-existing chronic conditions, hemorrhage and blood clots.

Modern obstetrics has taught us how to prevent many maternal deaths. We just need to do it.

Women’s Studies Prof. Chris Bobel’s book, The Paradox of Natural Mothering, is seventeen years old but reads as if it were written yesterday.

In Bobel’s view, natural mothering isn’t just a paradox, it is a plethora of paradoxes. Promoted as radical simplicity, parenting just like our foremothers and offering feminist empowerment, it is in many respects the complete opposite. It is a form of consumerism, confirms traditional misogynistic gender roles, and reflects and reinforces privilege.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The truth is that every caring mother follows her own intuition and does what feels right to her.[/pullquote]

Bobel seeks to understand not merely why advocates of natural mothering make the choices they do but how they perceive the choices they’ve made. Her assessment is spot-on:

…[N]atural mothers profess to operate in a realm virtually untouched by social influence. Their ideas, supposedly rooted in nature and fostered by their waxing self-confidence, are not the products of culture, but the products of nature. Natural mothering, then, is an organic experience. The experience of natural mothering is available to any woman who sheds her trust of others and taps into her trust in nature, a trust realized when she begins to trust herself…

But when Bobel asked natural mothers how they knew which mothering practices to choose, they repeatedly invoked intuition. They didn’t “know” what to do; they felt it.

It is clear that the reasons for natural mothering are often literally beyond reason. Rather than being rooted in an epistemology derived from the intellect, this type of “knowing” is intuitive, even instinctual and therefore defies explanation … Decisions are not ultimately based on thinking, but on feeling. Choosing a family bed, child-led weaning, or home birth is not based on reading a good book or even hearing a compelling argument, although those experiences often name dearly held beliefs that inform these decisions… For natural mothers, feeling both prefigures and constitutes her alternativity.

And that leads to yet another paradox, if decisions are made because they feel right to them, isn’t it equally likely that women who make choices of which they disapprove are doing so because it feels right to them?

Absolutely not! Women who make different choices are understood to be “bad other mothers.” The ideology of natural mothering [for it is an ideology, not a product of nature] has inoculated its advocates against the possibility of respecting the different choices of other mothers.

This mother … makes few conscious choices. Rather, she “goes with the flow” of the mainstream, seldom questioning the conventional wisdom that dictates so much of parenting practice. This mother is neither evil nor malicious, the natural mothers tell me; she is simply ignorant – duped by a powerful, child-hostile, expert-and institution-dependent culture.

You can identify her by the “terrible” choices she makes.

The “bad other mother” has her babies by planned cesarean section. She bottle-feeds because she does not want to be bothered by breastfeeding. She feeds her children hotdogs and potato chips for lunch because it is quick and easy. When her children complain of an car infection, she demands antibiotics but cannot understand why her children are chronically ill. She uses the television as an electronic babysitter. But perhaps the most common characterization zation of the “bad other mother” is the woman who insists that she must work, but really does so only “to support her addiction to materialism and careerism,” as one mother said.

The children of the “bad other mother” are imagined to be suffering.

Stories … were regularly invoked to prove the point that others choose wrongly. And their mistaken choices are evidenced by their harried, “miserable” lives. The natural mothers pride themselves on steering clear of the rushed life, the money-and status-driven life, ultimately, the unexamined life. The natural mothers tell me that they have risen above this fray and are never, ever going back.

The irony is that while they are busily criticizing women for copying ideas that are socially constructed, they fail to see that their own conception of good mothering is also socially constructed. Their choices are no more “free” than those of the bad other mothers they imagine as trapped by the conventions of contemporary society.

Whether the mothers are controlled by men or religion or some conception of nature, they are still controlled. Again and again, the natural mothers told me that they “just knew” that natural mothering was right; they could not mother in any other way and live with themselves… I argue that constructing structing a lifestyle on the basis of a body-derived feeling that can neither be explained nor denied is the action not of an agent, but of an individual who is dutifully following a script. In this case the script was written by biologically determinist and historically gendered ideas about women, mothers, and families.

To paraphrase Bobel, scratch the surface of a natural mothering advocate’s account of her brave refusal to follow the contemporary crowd and you will find a woman submissively following the dictates of her great-grandmother’s crowd.

Is that a bad thing?

No!

Because the truth is that there is NOT and there NEVER was a one-size-fits-all, best way to mother children. There is only each loving mother struggling to give each individual child what she feels that child needs.

The truth is that EVERY caring mother follows her own intuition and does what feels right to her.

The mother who chooses to have a homebirth is not more thoughtful than the mother who choose hospital birth; she’s just following an older social convention. The mother who chooses to breastfeed is not more caring than the mother who chooses to formula feed; she’s just making a different, equally healthy choice. The mother who “wears” her baby is not a better mother than the mother who uses a stroller; she’s just opting for a different form of convenience.

Unfortunately, natural mothering advocates have been taught to be contemptuous of women who make different parenting choices. They’ve been instructed that the only choices that are legitimate, authentic and worthy of respect are their own choices. And they’ve been encouraged to believe that they are better than other mothers.

The ugly desire to divide the world into us vs. them is not defiance of contemporary social convention, it is adherence to one of the oldest, ugliest forms of social conventions there it: the compulsion to privilege one’s own group by denigrating another.