Years ago, when I was working for a large health maintenance organization, I received a curious letter. It had come to their attention that my forceps rate (0%) was well below the average for obstetricians in our institution. I pointed out that my C-section rate was only 16% and I hadn’t left a single baby inside a mother. I asked if this were a problem? No one seemed to know.

At another point I got a notification that I had ordered more ultrasounds for my OB and GYN patients than average for that month. This time I asked whether any of the ultrasounds had been unnecessary? No one seemed to know … or care. It was just something they were required to measure.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The composite index DOESN’T tell us whether an individual hospital is a safe place to give birth.[/pullquote]

I mention these anecdotes because they illustrate the dangers of simply compiling statistics and comparing them. My employers wanted to know if I was delivering patients appropriately, but my forceps rate couldn’t tell them that. They wanted to know if I was ordering unnecessary ultrasounds but comparing my ordering rate to my colleagues in a given month couldn’t tell them that, either.

It is important to measure, but you have to be sure you are measuring the right thing in the right way.

That was my concern when I read the breathless report in USA Today, The secret number maternity hospitals don’t want you to know, and why we’re revealing it.

It is extremely important to measure maternal complication rates. But are the people at USA Today measuring the right thing in the right way?

It’s not clear to me that they are.

According to the article:

[I]n the United States – the most dangerous country in the developed world to give birth – maternity hospitals’ childbirth complication rates are a well-guarded secret.

Many hospitals know them. So do many state health agencies, insurance companies and researchers. But they fear the complication rates are too complex for regular folks to understand.

In truth, no one knows what they mean.

There are certainly questions about the data. Some hospitals are more likely to treat patients with health problems, so childbirth complication rates are difficult to compare. Some of the best-equipped hospitals in the country may have higher complication rates because mothers who are very sick get referred there.

But there’s more to it than that: How useful is the method they used, a “composite index”? How valuable is it to compare one hospital to another or any hospital to a mean value? What is it we really want to know and do the measurements chosen by USA Today tell us what we want to know?

We want to know several things that are extremely difficult to measure:

Is the complication rate for a given mix of patients appropriate?
Has every complication that could have been avoided been avoided?
Has the hospital staff caused complications?
And were the complications that occurred appropriately treated?

Where did the USA Today “secret number” come from?

More than a decade ago, the U.S. Centers for Disease Control and Prevention created a method for calculating how often women giving birth endure severe complications using diagnosis and procedure codes that hospitals record in patient billing records.

The resulting “severe maternal morbidity rate” is like a composite score of things that can go wrong at the hospital before, during or after delivery – heart attacks, strokes, blood transfusions, hysterectomies and other emergencies that can permanently harm or even kill a new mother.

The first problem is the inclusion of blood transfusions (often a minor complication) with far more serious complications.

[T]he CDC method uses blood transfusions as an indicator that a woman may have hemorrhaged. But it’s impossible from billing data to know whether the woman received one unit or many units of blood.

Some experts say that could inflate the rate. Others note that transfusions are counted for all hospitals and a blood transfusion is not part of a routine childbirth.

No it’s not routine, but it’s also not an indicator of severe complications. It would be far better to look at the rate for women who got 3 units of blood or more. A transfusion that large is a good indicator of a severe complication. So right off the bat, the composite index is almost certainly inaccurate in modeling severe complications.

The next problem: in order for any measurement to have meaning, we must adjust case mix so we are comparing like to like:

[S]ome hospitals have higher rates because they are specialty facilities where doctors send the riskiest cases. Some serve more poor mothers, who often get less consistent prenatal care. Others serve larger numbers of black mothers, who tend to have higher rates of certain health problems, such as hypertension, that can lead to serious complications.

What about just looking at the outliers? The article is accompanied by this graph:

Complication rates are distributed in a bell curve (a “normal distribution”) with a very long tail. (You can’t really see that because of the editorial decision to lump all hospitals over 5% together creating a spike at the end.) A normal distribution with a long tail has particular implications in public health.

As the authors of The “Long Tail” and Public Health: New Thinking for Addressing Health Disparities explain:

The prevailing approaches to improving population health emphasize “shifting the mean” through prevention efforts that target large groups at high risk or through mass environmental control interventions that encourage small but universal changes in individual behavior. This approach has led to the search for “blockbuster” public health interventions that can have the largest effects on determinants of population health and individual behavior…

In a compelling critique, Frohlich and Potvin argue that the prevailing population approach may have the unintended consequence of exacerbating health disparities. Disease risk, they point out, varies not just by behavioral risk factors but also by socially defined groups that vary in their exposure to fundamental risks, for example, low education and low socioeconomic status. Broadly targeted population interventions that focus primarily on behavioral determinants may not be as effective under these conditions or with these groups…

And that’s why simply comparing the composite index of one hospital to the composite index of another hospitals is not particularly helpful. Any hospital that is within the bell curve has an acceptable complication rate. Most hospitals in the long tail probably serve vulnerable populations and their complication rates may be more closely tied to socio-economic factors than to hospital competence.

But that’s not particularly eye catching when compared to a “secret number that hospitals don’t want you to know.”

So what does the USA Today composite index tell readers?

Not much that is useful for them.

No one should decide where to give birth based on the composite index since direct comparisons aren’t really possible and all hospitals in the normal distribution are probably as safe as the others in the normal distribution.

The hospitals in the long tail very likely serve high risk populations and the problem is not necessarily that they are providing poor care; they may be providing exactly the same care as the hospitals in the normal distribution but that isn’t enough for vulnerable populations.

The USA Today composite index can highlight facilities that deserve additional scrutiny but unfortunately it the CAN’T tell us whether an individual hospital is a safe place to give birth.

Dr. Gabrielle Colleran, why are you lying to women about breastfeeding?

According to attendees at a recent meeting of La Leche League Ireland, you claimed — falsely — that women who give birth but don’t breastfeed have a 4X increased risk of heart attack. The truth is that the scientific literature shows NO consistent relationship between breastfeeding and maternal cardiovascular disease.

You apparently claimed — in a remarkably vile and vicious falsehood — that both SIDS and childhood leukemia are twice as common in exclusively formula fed children, adding piously that this is very difficult information for parents.

It’s also a lie.

According to a recent comprehensive review of the breastfeeding literature, 3,500 mothers would need to breastfeed 3,500 babies to prevent one SIDS death. Moreover, pacifiers are MORE protective against SIDS than breastfeeding!

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Dr. Colleran, apologize and set the record straight. That’s the ethical thing to do![/pullquote]

The same review cautions that the association between breastfeeding and childhood leukemia is NOT firmly established and even if it were, 12,500 women would have to breastfeed 12,500 babies for more than 6 months to prevent one CASE.

I might have thought that the conference attendee was exaggerating or misunderstood the utterly false claims, but then I saw with my own eyes on the LLL Ireland Facebook page a snippet of video from your talk in which you claim, brazenly and falsely, that giving babies formula often leads to allergies. I shared the LLL Ireland post on my Facebook page and — surprise! — LLL Ireland deleted it.

Dr. Colleran, multiple people have asked you on Twitter to provide scientific references for your claims. As far as I can determine, you blocked each and every one of them. You blocked me even before I asked you.

I can’t imagine clearer sign that you KNOW your claims were lies than the fact that you block anyone who asks for proof and that LLL Ireland deleted the video evidence.

Dr. Colleran, we in medicine have a long and sordid history of lying to patients “for their own good.” As recently as the 1960’s doctors told cancer patients with a straight face and a clear conscience that they did not have cancer. Had those doctors been asked, they almost certainly would have justified their behavior by pointing out that patients given a cancer diagnosis often lost hope; it would be better for them to believe they had a less serious illness while the doctors treated them with chemotherapy without their consent.

This is paternalism.

Dr. Colleran, I know you are a pediatric radiologist, but I can tell you that we in obstetrics have a disturbing history of lying to patients “for the good of the baby.” While the current distrust of obstetricians by some patients has been assiduously fanned by midwives, doulas and natural childbirth experts, it could never have taken hold if obstetricians hadn’t already abused the trust of some patients. Natural childbirth advocates contemptuously refer to such behavior as “playing the dead baby card.” Even though it happens much less often than natural childbirth advocates believe, it does happen.

This is yet another, even less justified, form of paternalism.

Women have been in the forefront of holding doctors to account for paternalism. Some of the most well known legal cases that created informed consent law were brought by women. Furthermore, the natural childbirth movement itself was critical in changing paternalistic hospital practices around childbirth, empowering women as consumers of healthcare to whom hospitals and doctors now market medical services.

I doubt that they fought so aggressively against doctors lying to them “for their own good” so that lactation professionals could take up where other doctors left off — lying to women about the “risks” of not breastfeeding and the “risks” of infant formula.

Dr. Colleran, I suspect that you think you can hide from me and I will give up and go away. You don’t know me very well.

You owe new mothers clarification of and references for your outrageous claims. And if you can’t find references for your claims — because you know they don’t exist — you owe an apology to the attendees of the conference for misleading them. They believed you because you are a doctor. If you lied to them, they will take those lies and repeat them to patients “for their own good.” Both mothers and babies will be harmed.

You also owe an apology to new mothers, many of whom struggle with breastfeeding precisely because people like you apply tremendous pressure with fabricated claims of “benefits” of breastfeeding and “risks” of formula. No doubt you believe you are doing it “for their own good” or “for the good of the baby.”

But just as that doesn’t absolve doctors of the past for lying to patients, it most certainly doesn’t absolve you.

Dr. Colleran, apologize and set the record straight. That’s the ethical thing to do!

You might think I’d be happy about the censoring of anti-vaccine propaganda by social media. Over the years I’ve written extensively and in scathing terms about the ignorance, arrogance, and immorality of the anti-vax movement. There is no scientific evidence to support its claims; its promoters are quacks and charlatans; and it harms the most vulnerable among us.

And yet … I’m deeply uncomfortable.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The remedy for false speech is more speech, not enforced silence.[/pullquote]

I’ve also acknowledged the critical role played by social media in the rising popularity of what is basically a superstition. Just as there is no empirical support for fearing the number 13, there is no empirical support for the phobia around vaccination, a corollary of needle phobia.

The anti-vax movement has been around since the inception of vaccination over 200 years ago. It has been active in the US since colonial times. But, let’s face it, it’s a lot harder to spread conspiracies when you have to mimeograph crudely typed claims. It’s so much easier — an more persuasive — to congregate in the virtual space of social media to give support and encouragement to even the most bizarre beliefs.

And yet … I fear the consequences.

I have no doubt that censoring anti-vax propaganda on social media will be effective and will probably save lives. A sense of solidarity with others is critical for anti-vaxxers in defying nearly all doctors, scientists and public health officials in the world.

And yet … I worry that the cure might be worse than the disease.

Why? Because social media companies should not be in the business of deciding what people can read and say. Today it may be anti-vax propaganda; tomorrow it may be climate science, abortion science or something equally controversial.

Don’t get me wrong: I understand that Facebook, Twitter and Pinterest are private companies and therefore have complete discretion over the content they allow on their platforms. There is no question that it is legal for social media companies to censor speech.

I recognize that this is entirely different from government censorship, which is largely forbidden because of the First Amendment.

I’m generally not a fan of slippery slope arguments, yet I worry that we are at the top of a slope that is very slippery indeed.

Wait! Isn’t anti-vax propaganda unique in that it represents a public health problem? We’ve observed that rising fears around vaccination have led to declining immunization rates. We know that when rates decline below a certain point (different for each disease), the diseases will begin to reappear. We predicted the current outbreaks of measles and pertussis right down to the locations where they were most likely to appear.

But can we really argue that anti-vax propaganda represents a bigger health threat than climate change denial? Anti-vax propaganda makes it difficult to protect the most vulnerable among us — infants, the elderly and the immunocompromised. Climate change denial makes is nearly impossible to protect nearly ALL of us who are going to be profoundly impacted (possibly with deadly effect) by man made climate change. Yet Facebook, Twitter and Pinterest aren’t thinking about censoring climate denial.

Can we really argue that anti-vax propaganda represents a bigger public health problem than gun violence? To date, anti-vax propaganda sickens hundreds and kills very few. Widespread availability of guns kill tens of thousands of vulnerable, defenseless Americans (many of them children) EVERY year. Yet no social media platform is thinking about censoring gun rights talk.

So anti-vax propaganda is NOT unique as a form of speech that threatens public health.

Indeed, anti-vax propaganda is a subset of the massive industry of “alternative” health. Just about everything that travels under the imprimatur of alternative health is also propaganda — lacking scientific support, fabricating claims, harming individuals directly as well as by keeping them from getting real medical care.

If social media platforms are censoring anti-vax propaganda, shouldn’t they also be censoring fake cancer cures, outlandish restriction diets, and invocations to ingest supplements that are useless in the best case scenario and deadly in the worst case? If the justification for censoring anti-vax propaganda is that it is both unscientific and harmful, shouldn’t social media platforms be regulating ALL unscientific and harmful speech?

Who decides what is harmful enough to merit censorship? Who decides what is unscientific enough to merit being suppressed?

I suspect that I would have these concerns regardless of who was president, but if Donald Trump has done anything, he has alerted us to how very thin the veneer of democratic civilization really is.

Trump has made the previously theoretical risk of autocracy into an all too real risk. He has engaged in political vilification of disfavored people, disfavored political beliefs and disfavored public health organizations. If he were to “encourage” social media platforms to censor disfavored political speech under threat of tax or other financial penalties on the grounds that it is “harmful”, how would we differentiate that from censoring anti-vax propaganda?

Anti-vax propaganda is not hate speech but I wonder if we should treat it similarly. First Amendment advocates have always argued that the remedy for hate speech (which arguably harms, maims and kills more people than anti-vax propaganda) is MORE speech. As Supreme Court Justice Louis Brandeis wrote in the concurrence to Whitney v. California:

…[N]o danger flowing from speech can be deemed clear and present, unless the incidence of the evil apprehended is so imminent that it may befall before there is opportunity for full discussion. If there be time to expose through discussion the falsehood and fallacies, to avert the evil by the processes of education, the remedy to be applied is more speech, not enforced silence.

Brandeis was writing about what the government should and should not do, not private entities. As I acknowledged above, they are legally entitled to censor anti-vax propaganda. But that doesn’t mean that they should or that we ought to encourage them to do so.

There is no doubt in my mind that censoring anti-vax propaganda on social media will improve public health. My fear is that it will imperil intellectual freedom in the process.

The worst thing about contemporary lactivist culture is not that advocates of “Breast Is Best” disagree with advocates of “Fed Is Best.” The worst thing is that contemporary lactivist culture is a culture of contempt.

As I wrote last week, it often seems as if the unifying factor among lactation professionals — the concept around which they bond with each other — is not support for breastfeeding; it is contempt for women who don’t breastfeed. They appear to find fellowship in exacerbating and then celebrating the suffering of women whom they condemn as “minimal” mothers for not breastfeeding.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The contempt for “Fed Is Best” is a special kind of vicious.[/pullquote]

Because lactation professionals have contempt for those with whom they disagree, they continually exhibit what political scientist Arthur C. Brooks calls:

…a noxious brew of anger and disgust. And not just contempt for other people’s ideas, but also for other people. In the words of the philosopher Arthur Schopenhauer, contempt is “the unsullied conviction of the worthlessness of another.”

Brooks is writing about contemporary political culture but I was struck by the resemblance to contemporary breastfeeding culture. At its heart is fundamental attribution error (which Brooks calls motive attribution asymmetry):

the assumption that your ideology is based in love, while your opponent’s is based in hate — suggests an answer… Each side thinks it is driven by benevolence, while the other is evil and motivated by hatred — and is therefore an enemy with whom one cannot negotiate or compromise.

However, in this case I believe lactation professionals suffer from fundamental attribution error while “Fed Is Best” advocates do not.

Based on their writings, contemporary lactation professionals (and most definitely their leaders) believe that their ideology is driven by love for babies and the “opposition” is driven by hate for breastfeeding. Lactation professionals like Amy Brown, Lucy M. Sullivan, Kimberly Seals Allers and Jack Newman believe themselves to be benevolent while I, Christie del Castillo-Hegyi and Jody Seagraves-Daly are evil and should be ignored let alone compromised with. In contrast, I haven’t found a single “Fed Is Best” advocate who hates breastfeeding. And we have spent an inordinate amount of time desperately trying to speak with and inform lactation professionals.

The examples are too numerous to count, but here’s what I’ve observed in the past month alone.

Two weeks ago I left a comment on a post on Dr. Jack Newman’s Facebook page:

Dr. Newman, since you are so sure breastfeeding has substantial benefits, can you please show us any impact that changing breastfeeding rates have had on term infant mortality or any metrics of major term infant morbidity. To my knowledge, the only impact breastfeeding has had on these parameters is a dramatic increase in the rate of neonatal hospital readmission. Indeed exclusive breastfeeding is now the leading risk factor for readmission. So I see the risks, but I can’t find the benefits. Can you show us the population data that supports your claims?

It’s a simple request, respectfully presented. Dr. Newman contemptuously deleted it.

Last week I came across this contemptuous screed from Maureen Minchin, a lactation professional (with no training in science or medicine) who has a self-published book on — I’m not kidding — breastfeeding and immunology. In response to a woman who complained about her lack of sympathy and concern for women who cannot breastfeed, Maureen produced this and it’s a special kind of vicious:

… I am sorry that you had such a hard time with your first, and understand your rage, and your decision to go with formula for your second, and I am glad that worked out so well for you. It doesn’t for some other people, and that’s the point: we can’t know ahead of time which children will be badly affected, but some will, in every country, some will die in every country, and all will develop differently from what they would have done if breastfed. That’s just biological fact…

You have been the victim of what I have been working – mostly gratis – to remedy for decades: poor education and clinical practice about infant feeding, not just breastfeeding. It’s a shame you never had an enjoyable breastfeeding experience and that your son was put at risk. But as you say, environment also matters, and I’m sure he’s had the best you can provide…

I am not in the business of making people feel guilty and it upsets me if mothers tell me they are hurt by hearing truths that need to be told. Partly because it means the mother is so focussed on her own history and family that she cannot see the much bigger picture, and truly believes that in order to avoid upsetting those already victims of formula culture in WEIRD [Western, educated, and from industrialized, rich, and democratic] nations, we should stay silent and allow more families everywhere to be affected by it…

You cannot be so self-centred as to think that the feelings of those already formula feeding matter more than the lives and health of others…

I would be happy to supply you with a free copy of my books should you undertake to read them in full, cover to cover…

All best wishes, Maureen

Last night I saw this from Meg Nagle, the Milk Meg:

“Fed” is not best. Fed is the minimum…

Could there be anything more cruel than telling a mother who loves her baby desperately and is already suffering shame and guilt over the inability to breastfeed that she is giving her child only the “minimum”?

I also came across this last night:

Who is Gabrielle Colleran? She’s a pediatric radiologist and I read that she claimed that fat is laid down during pregnancy for breastfeeding. This fat supposedly poses a risk if not “used up” by producing breastmilk. According to Dr. Colleran, women who were pregnant but did not breastfeed are 4 times more likely to have a heart attack.

That’s news to me so I reached out for clarification. I was already blocked even though I had never heard of her and her theories previously. It’s hard to imagine anything more contemptuous than preemptively blocking another physician who might ask for proof of your claims.

The world would be a better place is lactation professionals would heed Brooks’ call for better quality disagreements:

What we need is not to disagree less, but to disagree better. And that starts when you turn away the rhetorical dope peddlers — the powerful people on your own side who are profiting from the culture of contempt. As satisfying as it can feel to hear that your foes are irredeemable, stupid and deviant, remember: When you find yourself hating something, someone is making money or winning elections or getting more famous and powerful. Unless a leader is actually teaching you something you didn’t know or expanding your worldview and moral outlook, you are being used.

Lactation professionals should engage with “Fed Is Best” advocates. They owe it to women and babies to respond to challenges to their core beliefs because their core beliefs may be wrong and even harmful.

And “Breast Is Best” partisans need to reject the powerful people on their own side who profiting from the culture of contempt. As satisfying as it can be to hear that women who don’t breastfeeding are lazy, self-absorbed, bad mothers and as enjoyable as it can feel to hear that medical professionals who question the benefits of breastfeeding are irredeemable, stupid, deviant trolls, remember:

When you find yourself hating those who believe “fed is best” someone is making money. Is your goal to enrich your leaders or is it to help babies and mothers? Sadly, you can’t have both.

There are many ironies embedded within the philosophy of natural mothering.

Chief among them are the mindless embrace of mothering in nature without acknowledging the natural death toll and the fact that our ancient foremothers would have cut off their right arms for the lifesaving medical technology privileged white women ostentatiously reject in performative social media displays.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Children, like plants, are tropic. Plants grow toward the sun. Children grow toward those who love them.[/pullquote]

But in my view, having written about the subject for more than a decade, the cruelest irony is that “natural” mothering is based on the medicalization of love.

What do I mean?

Before the past century in highly industrialized societies, the bond between mother and child was understood as spontaneous and not contingent on any specific practices. Children, like plants, are tropic. Plants grow toward the sun. Children grow toward those who love them.

Natural mothering advocates, in contrast, imagine mother-infant attachment to be a fraught process constantly shadowed by the looming risk that mother and child will fail to bond. Therefore, they have medicalized it.

The Wikipedia definition of medicalization postulates two central claims:

Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment…

Medicalization is studied from a sociologic perspective in terms of the role and power of professionals, patients, and corporations, and also for its implications for ordinary people whose self-identity and life decisions may depend on the prevailing concepts of health and illness.

In other words, a natural process previously understood to have no medical component comes to be defined as a medical condition to be studied and treated. And the process of medicalization transfers power from individuals to “experts.”

Natural mothering has medicalized love, a process previously understood to have no medical component. Medicalizing the mother-infant bond has empowered self-appointed experts like midwives, doulas, lactation consultants and attachment parenting gurus. With their books, courses and social media sites, they have become the arbiters and mediators of mother-child relationships.

I find the principles of the technocratic model of childbirth, described by sociologist Robbie Davis-Floyd, to be an excellent template for the technocratic model of love.

I would paraphrase David-Floyd as follows:

Despite its pretensions to scientific rigor, natural mothering ideology is less grounded in science than in its wider cultural context; it embodies the biases and beliefs about women of the society that created it. Its hegemony is founded in scientization, effected by technology, and carried out through institutions governed by paternalistic ideologies in a profit-driven economic context.

Within the technocratic model of love, midwives, doulas, lactation consultants and attachment parenting “experts” claim scientific rigor (although they lack it), proselytize through technology like the internet (though they claim to despise technology), and monetize everything that isn’t nailed to the floor.

The tenets of the technocratic model of love include:

The body as machine

In contrast to the previous view of mother-infant bonding as primarily spiritual — thereby encompassing the love between mothers and adopted children, the love of children for mothers who never breastfed them (indeed in wealthy families they may have been breastfed by others) and the fierce love between infants and other family members — natural mothering advocates have reduced it to mechanical behaviors that they claim are necessary preconditions to attachment. Natural mothering experts have insisted that unmedicated vaginal birth, breastfeeding, and continuous physical proximity are the necessary preconditions for love.

The patient as object

Natural parenting experts don’t view mothers as individuals. It seems not to cross their minds that different mothers may have different needs, desires and attachment styles. Instead, mothers are viewed as the objects to be molded by aggressive education efforts in conjunction with selling them books, courses, and accessories.

Babies, too, are viewed as objects to be acted upon, each in exactly the same way as all others. Unmedicated vaginal birth is supposed to be “best” for every baby even though when unmedicated vaginal birth was the only method of birth perinatal mortality was astronomical. Breastfeeding is supposed to be “best” for every baby, even though when breastfeeding was the only method of feeding available infant mortality was astronomical. Baby wearing and the family bed are supposed to be “best” for every baby despite the fact that generations of babies fully bonded to mothers, fathers, grandparents and hired caregivers without either.

Diagnosis and treatment from the outside in

Although natural mothering experts purportedly celebrate maternal instinct, close examination reveals that maternal instinct is only promoted to the extent that it differs with recommendations of medical professionals. In reality, it is entirely ignored when the mother’s instinct conflicts with the ideology (and profits) of natural parenting experts. Maternal request C-sections are viewed with horror by midwives and doulas; formula is viewed with horror by lactation consultants; playpens and strollers are viewed with horror by attachment parenting advocates. Natural parenting experts routinely prescribe behaviors and choices to mothers instead of trusting mothers to make good decisions by themselves.

Authority vested in experts, not in mothers

The central conceit of natural parenting is that its practitioners are recapitulating mothering in nature. But mothering in nature did not rely on books, courses and social media interactions. However books, courses and social media interactions are the only way for experts to maintain control of patients, and the expert considers HER oversight and control over birth, breastfeeding and early parenting to be mandatory.

Supervaluation of science, even non-existent “science”

Natural mothering experts believe that invocation of science enhances their authority and hides their paternalism. They’re not forcing women to forgo epidurals; science “shows” epidurals are dangerous (it does not). they’re not forcing women to breastfeed; science shows breastfeeding has massive health benefits (it does not).

Aggressive intervention with emphasis on short term goals

Is there anything more aggressive than the unsafe, unethical Baby Friendly Hospital Initiative? Is there any program more focused on irrelevant, short term goals — increasing rates of exclusive breastfeeding at discharge — at the expense of the health of both mothers and babies than the BFHI?

Expert hegemony, a profit driven system, and intolerance of other choices

That’s self-explanatory.

In truth, the ultimate irony of natural mothering is that it has come to embody everything it claimed to resent about the medicalization of birth. It is based on a technocratic model of mother-infant love rather than a spiritual model and, as such, it benefits natural mothering experts at the expense of babies and mothers.

Let’s have a round of applause for lactivist Charlotte Young, the Analytical Armadillo and founder of Milk Matters UK. She briefly ventured out of her social media echo chamber and — asked to demonstrate that the benefits of breastfeeding are real — promptly scurried back.

Young illustrates in the most emphatic way possible that no mother should worry her baby missed out on the benefits of breastfeeding. They are clearly so trivial that even a committed lactivist who presumably has command of the breastfeeding literature CAN’T find any evidence that they occur.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Asked to provide data that the claimed benefits of breastfeeding really exist Charlotte Young, the Analytical Armadillo, couldn’t.[/pullquote]

Nonetheless she deserves credit for being willing to at least sniff the air outside the echo chamber. Other lactation professionals like Prof. Amy Brown, Lucy Martinez Sullivan, Kimberly Seals Allers and Dr. Jack (“formula is like a condom”) Newman can’t even manage that. Sure, they tell themselves that they block and ban me because I’m a “troll,” and maybe they even believe it. But the real reason they block me is because I keep asking an uncomfortable question that they cannot answer:

If breastfeeding has the benefits claimed by lactivists, why can’t we detect them in large populations?

It is lactivists themselves who have handed me the means I use to easily discredit them. They have created and aggressively promoted mathematical models (and even a “calculator”) that to purport to show how many diseases could be prevented and lives and healthcare dollars saved if more women breastfed. It’s a nifty method for pressuring new mothers and — even more importantly! — pressuring governments to subsidize lactation professionals.

Lactivists failed to consider that their models could be applied as easily to the past as to the future. When you put in data for the years since 1973, when breastfeeding rates in the US reached their nadir, the calculator makes grandiose predictions for the diseases prevented, and lives and healthcare dollars that should have been saved by now. Yet, to their shock and dismay, lactation professionals can’t find them. In technical terms that means that they never bothered to validate their models and that their models are obviously and fatally flawed.

But back to the Analytical Armadillo. In writing a recent piece decrying gaslighting and strawmen, Young gives a masterclass in — you guessed it — gaslighting and strawmen. I’ll let you read it for yourself and you will see that it doesn’t even make sense. I posted it on the Skeptical OB Facebook page with the comment:

AA, which part of “You-are-hurting-babies-and-mothers!” are you having trouble understanding?

Instead of ignoring women’s pain and concerns (gaslighting), why not try LISTENING to what THEY are saying instead?

Young promptly appeared with what she presumably regards as a witty rejoinder:

You might need to read it again, I’m not sure you’ve entirely understood – perhaps you were triggered, half my client base are formula feeders…

I asked a simple question and she promptly scurried back to her burrow:

[C]an you show any population data for term babies in industrialized countries that demonstrates ANY detectable benefit in rates of mortality and severe morbidity from increased breastfeeding rates?

This is the part that I want women who feel fearful or guilty about using formula to pay close attention to: these are simple questions that Young cannot answer. If breastfeeding truly had the benefits lactation professionals claim, she should be inundating me with data.

Instead she is trying to baffle her followers with bullshit.

That’s because she alerted her Facebook followers to the fact that I was discussing her piece. I’ve included the link because you must read it; it is comedy gold! Lots of snark, not a single piece of data.

Where’s the evidence that increased breastfeeding has reduced the incidence of any serious disease? Young can’t find any.

Where’s the evidence that increased breastfeeding has saved lives of term babies? Young can’t find any?

Where’s the evidence that increased breastfeeding has saved healthcare dollars? Once again Young comes up short.

And if Charlotte Young, the Analytical Armadillo and founder of Milk Matters UK, can’t manage to find ANY evidence that increased breastfeeding rates have had ANY detectable impact on term infant mortality or serious morbidity, you know that it doesn’t.

So thank you, AA, for dropping by. You’ve (inadvertently) offered yet more comfort and support to women who might be feeling fearful or guilty for giving their babies formula, and yet more encouragement for women who want to formula feed but are holding back.

You’ve demonstrated in the clearest way possible that most of purported “benefits” of breastfeeding exist only in lactivists’ imaginations, not in real life. That’s a public service!

Lactation professionals are easily triggered by any positive discussion of formula feeding.

What does that mean?

To be triggered is to experience a strong reaction of shock, anger or fear in response something another person said or wrote. For example, many lactation professionals seem to have experienced tremendous shock, anger and fear in response to Nathaniel Popper’s NYTimes piece extolling the unanticipated joy of formula feeding his baby.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Defensive Lactation Professionals welcome the process of getting offended and are attracted to media which triggers them.[/pullquote]

Their overwrought response — accusing the father of controlling his wife, claiming that the piece was created by a formula company algorithm, blaming the patriarchy for his wife’s difficult with breastfeeding — illustrate their extreme defensiveness.

But that’s hardly the only indication of a ‘Defensive Lactation Professional’ (DLP for short).

Victim Mentality

If there is one thing Defensive Lactation Professionals are sure of it’s that they are victims.

They are victims of evil multi-national formula companies who (they imagine) quake at the thought of women actually breastfeeding their babies.

They are victims of a culture that — despite spending millions of dollars to promote breastfeeding and engaging in massive public health campaigns to support breastfeeding — is secretly hostile to breastfeeding.

They are victims of pediatricians and nurses who care more about whether a baby lives or dies than whether it is breastfed.

Therefore, Defensive Lactation Professionals see any positive discussion of formula as an opportunity to recite their ever-lengthening list of ever more arcane “benefits” of breastfeeding. How many times have you seen a perfectly reasonable discussion of formula feeding sabotaged by a DLP with the immortal words, “You could have breastfed if you’d had more support!”?

Facebook and Twitter are dangerous places for Defensive Lactation Professionals. They are always alert for the worst, as it is full of evil women who desire nothing more than to eradicate breastfeeding. In their view, it is a harsh environment of victims (themselves), victimizers (everyone else), and occasional rescuers (other DLPs who send them hugs).

But social media is also a place where like attracts like, so it only makes sense that DLPs attract people like them, united in their shared contempt for formula feeders. When you’re in a social situation and everyone is expressing relief at how much better their babies are growing, how much easier it is to formula feed, and how they can share the burden with partners and family members, it’s so comforting to band together with other DLPs to accuse formula feeders of laziness, selfishness and not caring enough to give their babies the very “best.”

Arrogance

The arrogance of DLPs is often a very subtle and indirect way of expressing cruelty without openly acknowledging it.

Consider this exchange with Doula Maddie on Twitter.

A physician and cancer survivor responded to Maddie’s insistence that everyone can breastfeed, writing:

Hi.I had a double mastectomy for breast cancer age 28. I’m fascinated to hear that ALL women can breastfeed. I would really value your insight into how I could have achieved better for my 3 bottlefed children given my total absence of mammary tissue?

And Maddie, in a response that should win an Oscar for “Cruelty in a Supporting Role” immediately responded with this:

IF you want to …

It’s accompanied by a picture of a baby nursing from a women’s breast with the feeding tube of a supplemental nursing system taped along side the nipple.

Which part of ‘double mastectomy’ did Maddie fail to understand? The doctor has NO breast tissue and NO nipples. What exactly would that SNS be taped to?

Passive Aggressiveness

Defensive Lactation Professionals seem superficially to acknowledging the reality of insufficient breastmilk, breastfeeding pain and demanding jobs incompatible with pumping, but are experts in passive aggressive “suggestions.” For example, they may ask if you have hired a lactation consultant, pumped after every feeding and taken medication to boost supply, but they don’t care about the answer. Regardless of your personal circumstances, and regardless of the fact that you’ve already tried all their suggestions, they are “sure” that you could have breastfed if you’d only tried harder.

In the online environment, within minutes their behaviour will escalate. They will ascribe non-existent negative intentions to neutral statements, sulk, pout, withdraw, bungle, make excuses, and lie. Their talent at sending mixed messages catches others off-guard. One minute they’re having a civil conversation, then they’re offended, then they claim to enjoy the debate, then they are angry. Their behaviour appears very schizophrenic as they battle with their inner demons on the public stage of the internet forum or Facebook page.

A common theatrical performance of a DLP is to post in a discussion of the merits of formula feeding:

“I’m leaving this terrible page; you are all shills for formula companies!”

… and then staying. That’s unfortunate; actually leaving would have produced a sigh of relief from everyone else.

Attention Seeking

This behaviour has a self-defeating, almost masochistic quality. It is as if Defensive Lactation Professionals welcome the process of getting offended and are attracted to media which triggers them. They actively seek out formula support forums, blogs and advocates where they enjoy arguing. They tell themselves they are “informing” others.

To compound the negativity of this outlook, Defensive Lactation Professionals are experts in inflaming others. They have a knack for dragging others into the emotional maelstrom they create, keeping them off-balance with their talent for moving the goalposts. “You could have breastfed!” “But antibodies!” “Why not donor milk?”

They are also masters of manipulation, which can make interactions with them infuriating. It is almost as if they want to offend people, only to prove to themselves that they are being persecuted. Their talent for high drama draws other Defensive Lactation Professionals to them like moths to a flame. They gain short-term pleasure from feeling sorry for themselves or eliciting pity from each other.

But when formula feeders respond with real life experiences or with scientific evidence that undermines their claims, Defensive Lactation Professionals respond by …

Deleting, Blocking and Banning

This behavior is the truest indication of their defensiveness. Rather than gracefully acknowledging that breast is NOT best for every baby and every mother, they delete testimony from women whose babies were hospitalized, suffered brain injuries or even died as a result of insufficient breastmilk.

Rather than addressing the large and growing body of evidence that most of the purported benefits of breastfeeding disappear when corrected for maternal education and socio-economic class, they block other professionals who present that data.

When faced with the papers detailing how the Baby Friendly Hospital Initiative ignores the scientific evidence on pacifiers, formula supplementation and the fact the exclusive breastfeeding is the single greatest risk factor for newborn hospital readmission, Defensive Lactation Professionals delete the “offending” evidence and ban the commentor from their Facebook page.

This is particularly insupportable in a group of people who claim to be professionals. No real professional blocks another professional from asking them to address the scientific evidence. No real academic shies away from public disagreement, refusing to venture into scientific conferences where they can be challenged, preferring to huddle within their social media echo chambers rebuffing attempts at engagement.

You could create a bingo card with these DLP traits: victim mentality; arrogance; passive aggressiveness; attention seeking; deleting, blocking and banning. Next time you encounter a Defensive Lactation Professional, have a mental image of this bingo card and see how many traits you can spot.

Popcorn optional.

 

Some may have already recognized that this is a riff on an old piece from the Alpha Parent.

Remember the biblical story of David and Bathsheba?

David, while walking on the roof of his palace, saw a very beautiful woman bathing. He ordered enquiries and found out that she was Bathsheba, wife of Uriah. He desired her …

[T]he king gave the order to his general, Joab, that Uriah should be placed on the front lines of the battle, where Uriah would be more likely to die. David had Uriah himself carry the message that led to his death. After Uriah had been killed, David married Bathsheba.

Not surprisingly, God was very angry with David.

Imagine if David, to absolve himself of responsibility, had responded: “But Goliath!”

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Wailing “But formula companies!” does not absolve lactation professionals for their execrable treatment of women who don’t breastfeed.[/pullquote]

That’s not what happened in the Bible; David recognized that he had become Goliath.

But it is what happens whenever you try to call lactation professionals to account over their execrable behavior toward women who can’t or don’t want to breastfeed. When you point it out, they routinely respond: “But formula companies!”

Lactation professionals fail to understand two things King David understood immediately.

Just because you were the underdog in one situation does not mean that you aren’t the powerful person in another. Just because you were once the underdog, does not leave you free to abuse the power you do have.

When David faced the giant Goliath, he was the underdog. But over time he acquired greater power, eventually becoming king. He now had power over others.

Similarly, when lactation professionals first faced off against formula companies, they were relatively powerless. But over time they have acquired greater power, eventually becoming arbiters of all things breastfeeding within and outside hospitals. They now have power over others: vulnerable new mothers struggling to care for their babies.

Like King David abusing his power to get what he wanted, lactation professionals are abusing their power to get what they want: a world where all women MUST breastfeed or face social opprobrium.

David had enough power to arrange for Bathsheba’s husband to die. Lactation professionals have only enough power to kill women’s spirit and they have taken to the task with relish.

They abhor the Fed Is Best Foundation and its founders. They abhor medical professionals like me who disagree with them. They even abhor fathers who dare to love formula feeding.

Journalist Nathaniel Popper had a beautiful piece the NYTimes this past weekend, What Baby Formula Does for Fathers:

Now when my son cried in the night, or out in public, I instinctively started toward him. Before this, my wife had been the first responder because we assumed that he probably needed to be fed. Now, I was just as capable of feeding him as she was. This meant that I not only fed him, but learned about all the times when he wasn’t actually hungry but needed a burp or a clean diaper, or something else that we couldn’t figure out, but that was part of the essential mystery of parenting. I came to understand his rhythms and needs.

Lactivist “mean girls” (professional and lay) have responded with unmitigated fury! And they’ve created a new version of underdogma: “But the patriarchy!”

Prof. Amy Brown:

Wants wife’s bodily function to fail so he gets to do what he wants. Can you imagine a woman writing this about a male body part. Oh I hope it fails so I can use what I really want to…

Elizabeth Grattan:

He used the same straw man tropes about nursing or not that so many are striving to strip from these discussions in this sexist garbage op ed. It’s such a grotesque narrative. And it panders. Just awful.

Lucy Martinez Sullivan:

There are also a handful [of] people who think this Op-Ed was written by an algorithm programmed by a formula company.

Prof. Cecilia Tomori:

It’s 2019 and yet we have a piece in the NYTimes that promotes formula as way to achieve gender equity in parenting. Because you can’t possibly bond with babies if you are not breastfeeding them. The astounding privilege and ethnocentrism in this piece is mindblowing.

Have these women lost their minds? How dare any father offer love and support to a wife who struggled with breastfeeding! How dare he enjoy bottle feeding!

But if you are looking for a true WTF experience, you must read Doula Maddie’s febrile ravings!

You may remember doula Maddie MacMahon from her musings on the subject of vaginal exams during childbirth:

Midwives shld be debating the pros and cons of routine VEs and exploring the evidence, or lack of, for regularly fossicking around in a normal labour. I’m just a woman telling you that you need a damn good reason to finger me. Just telling me I’m Xcm is not a good enough reason.

So I wasn’t exactly expecting moderation when I read her piece, but damn, the woman is self-absorbed and self-aggrandizing.

She analogized breastfeeding support to the story of Cinderella:

How does she view herself? She the Fairy Godmother!

Bear with me – I’m not on a massive ego trip here.

Are you sure about that?

Fairy Godmother can, when required, conjure up powerful magic – she can sometimes tempt non-latching babies to suckle or take a mother from agony to comfort with some small, subtle adjustments to the posture of the mother and the position of the baby. Her wand is often wielded with a light touch – it might not, if you are watching her, look like she is doing much. Her magic is rarely loud and glamorous or even instant. Rather, it works delicately and leaves the mother feeling like she has found her own answers. Fairy Godmothers are often called Breastfeeding Counsellors, Breastfeeding Supporters, LLL Leaders or International Board Certified Lactation Consultants…

What about those who support women in whatever feeding method THEY feel is best for their babies. They’re the Wicked Stepmother. (Maddie has all the subtlety of a sledgehammer!)

Wicked Stepmothers might be working for formula companies’ care lines or appear as a media-savvy ‘guru’ or ‘expert’; a nanny with her own TV show or parenting book. She might be a blogger or active on social media …

And the baby’s father? He’s the Prince of Patriarchy (I kid you not)!

I hope Cinders really did love him and that he empowers her in an equal partnership. I hope he doesn’t think he can just strut in and fix Cinders. But I suspect he is the actually symbolic of the Patriarchy, consistently ignoring and cutting services for women so that under-trained coachmen, stepmothers and ugly sisters are created and given free rein to continue sabotaging breastfeeding. The Prince rules – he gets to decide what commercial influences and social injustices can negatively impact your breastfeeding journey.

Is this woman for real? Sadly she represents and is embraced by other lactation professionals. They envision themselves as small compared to the power of the formula industry and the patriarchy. They imagine themselves as David against Goliath.

They fail to see what David recognized. They’ve become Goliath.

David acknowledged that his treatment of Uriah and Bathsheba could not be defended by falling back on his previous good deeds. Lactation professionals need to acknowledge that their vicious treatment of women who can’t or don’t breastfeed cannot be defended by falling back on their previous good deeds.

Lactation professionals, you are not the good guys here. Like David, you are trying to eliminate anyone who gets in the way of your desires, while ignoring the desires of the people whom you manipulate. And no amount of wailing “But formula companies!” or “But the patriarchy!” can justify that.

Fed is minimal.

Is there anything more emotionally abusive than this “rebuttal” to the Fed Is Best campaign?

The definition of minimal is:

barely adequate or the least possible

Could there be anything more cruel than telling a mother who couldn’t or didn’t want to breastfeed her child that SHE is barely adequate?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It often seems that for lactation professionals, the cruelty is the point. They find fellowship in contempt for women who don’t breastfeed.[/pullquote]

The Fed Is Best Foundation was started to protect infants from dehydration, severe jaundice, brain damage and death, all of which have been rising alarmingly since the advent of the Baby Friendly Hospital Initiative.

While infant health remains the primary focus, the Foundation also provides support to all women regardless of how they feed their babies. As anyone who is part of their many groups can see, that support comforts women who are struggling with deep emotional pain, depression and self-hatred.

Is there anything more vile than when faced with that pain, lactation professionals responded NOT with compassion, but with cruelty?

Prof. Amy Brown, in her subtly titled piece Why Fed Will Never Be Best, writes:

…Fed is therefore not best, because best implies that there are other acceptable alternatives.

Secondly, at what other point in our lives do we believe that fed is best? With older children do we accept that any food at all is best? No. We campaign for children to receive optimal nutrition. As adults we know that diet can play a major role in our health and wellbeing so why would this be any different for those whose sole nutrition comes from their milk?

Cruella de Vil could not have said it better!

Amy Brown is hardly alone among lactation professionals in her viciousness. Dr. Jack Newman famously had this to say about formula feeding:

Dr. Jack Newman, author of The Ultimate Breastfeeding Book of Answers, contends that “no close holding of the bottle-fed baby can duplicate the nursing relationship.” We asked whether there are any studies that support his thesis. “Feeding a baby with a bottle is akin to making love with a condom,” replied Dr. Newman, who founded the Newman Breastfeeding Clinic and Institute in Toronto. “Ask the men. They’ll tell you direct contact is different.”

Kathy Dettwyler wrote TO a mother who had left a positive review of Courtney Jung’s book Lactivism on Amazon:

Your children may or may not be “inferior” to breastfed kids … But formula-fed children definitely WILL BE INFERIOR to how those same individuals would have turned out if they had been breastfed.

Not to be outdone, Kimberly Seals Allers counsels women to ignore pediatricians when they warn about the dangers of exclusive breastfeeding, now the single largest risk factor for newborn hospital readmission accounting for tens of thousands of readmission each year.

No one would accept a nutritionist trained at a’McDonalds Health Institute’ but every day mamas face pediatricians only trained in breastfeeding by infant formula industry. The ones who financially benefit from failure of breastfeeding. We deserve better!

What proof does she offer for this slander? None of course.

These statements, and others like them, constitute a clear pattern of emotional abuse. They involve many of the behaviors commonly associated with abuse:

Denying something you know is true. An abuser will deny that an argument or even an agreement took place. This is called gaslighting. It’s meant to make you question your own memory and sanity.

Using guilt…

Denying their abuse. When you complain about their attacks, abusers will deny it, seemingly bewildered at the very thought of it.

Accusing you of abuse. They say you’re the one who has anger and control issues and they’re the helpless victim.

Trivializing. When you want to talk about your hurt feelings, they accuse you of overreacting and making mountains out of molehills.

Saying you have no sense of humor… If you object [to vicious accusations], they’ll tell you to lighten up.

If you want to see the emotional abuse in real time, check out the Twitter feeds/Facebook pages of the lactation professionals mentioned above and those of their colleagues.

Over and over again, I have been astounded to see the obvious pain of new mothers met with a wall of derision, gaslighting, dismissal and contempt. Twitter in particular is the mean girls’ equivalent of the lunch room table. Lactation professionals won’t let anyone who is not a part of their clique sit near them; you can almost see the eye rolling and hear the cruel laughter. Lactation professionals often freeze suffering women out altogether by blocking them completely.

It often seems as if the unifying factor among lactation professionals — the concept around which they bond with each other — is not support for breastfeeding; it is contempt for women who don’t breastfeed. They appear to find fellowship in exacerbating and then celebrating the suffering of women whom they condemn as “minimal” mothers for not breastfeeding.

That’s why it’s so hard to stop their cruel behavior; it has become a social ritual for lactation professionals. Like all bullying, it isn’t just about tormenting someone else; it’s about impressing one’s peers by jointly tormenting others.

Fed is minimal? Only if the cruelty is the point.

You might think — I always have — that childbirth is about the birth of a healthy baby to a healthy mother. But according to many midwives, that isn’t enough. A mother’s birth experience is deemed critical and the experience is apparently ruined by technological interventions. Hence the dangerous campaigns for “normal birth,” defined as birth without any interventions, any machines or any surgery.

Indeed, midwives wax lyrical on the subject of the medicalization of childbirth, forcefully arguing that most babies would be fine without intervention of any kind, insisting that doctors have medicalized childbirth for their own benefit, and claiming that doctors cause emergencies so they can heroically step in and “save” their patients.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactation professionals have created breastfeeding “emergencies” from which they heroically “save” babies. But most of these emergencies have been caused by lactation professionals themselves.[/pullquote]

Clearly, medicalization is a very, very bad thing … until it comes to infant feeding. With infant feeding medicalization isn’t just awesome, it is absolutely necessary.

You might think — I always have — that infant feeding is about providing a developmentally and nutritionally appropriate food resulting in a healthy baby and a healthy mother. But according to lactation professionals, that isn’t enough. Trivial benefits and fabricated benefits are deemed critical to infants who are apparently ruined by formula. And any intervention, no matter how artificial, burdensome or technological — including surgery on babies — is not merely justified, but necessary. The mother’s breastfeeding experience? That’s irrelevant!

But I’m here to tell you that the medicalization of infant feeding is harming babies and mothers. We KNOW, though generations of experience involving millions of babies, that term infants will be healthy on formula. And I have come to believe that lactation professionals have medicalized infant feeding for their own benefit, creating feeding “emergencies” so that they can heroically step in and “save” patients breastfeeding.

Wait, don’t lactation professionals say that breastfeeding must be best because it is natural? Don’t they demonize formula because it is technological?

Yes, they say that, but their behavior belies their rhetoric.

First, breastfeeding is apparently a bodily function that is outside the natural realm of other bodily functions, all of which have failure rates. Most women won’t conceive the first month they try to become pregnant; up to 20% of established pregnancies end in miscarriage. Breastfeeding, too, has a natural failure rate: up to 15% of first time mothers will not be able to produce enough milk to fully nourish an infant, especially in the first few days after birth. Some babies are incapable of fully draining the breast. Furthermore, just as some pregnancies aren’t wanted and will be terminated, some women have no desire to breastfeed.

But not according to lactation professionals. To hear them tell it, breastfeeding is perfectly designed for every mother and every baby and failures rates are exceeding low. Moreover, all good mothers want to breastfeed; only inferior, lazy women who are dupes of the formula industry and lack lactation support would ever consider formula.

Second, the process of infant feeding itself has been medicalized. For most of human history, infant feeding involved giving infants food so they could grow. In our contemporary culture — with its twin emphases on intensive mothering and reducing risks — breastfeeding has recently acquired all sorts of medical benefits ranging from the trivial (8% fewer colds and 8% fewer episodes of diarrheal illness across the entire population of infants in their first year), to major “benefits” (supposedly increased IQ, decreased risk of allergic disease, improved long term health), all of which disappear when socio-economic status is taken into account. Therefore, ever more arcane, highly technological benefits are dreamed up like a “better” microbiome or “better” epigenetics for which there is only speculation and no actual evidence at all.

Third, any and all technology, no matter how invasive, is embraced if it results in more women breastfeeding for longer.

Don’t produce enough breastmilk to fully nourish your baby? Pump after every feeding with an electric pump whose plastic parts are strapped to your body! Take drugs like domperidone!

Baby having trouble extracting milk from the breast? Tape a plastic Supplemental Nutrition System (SNS) to your nipple in order to feed the milk that you pumped! Or perform surgery on the baby’s tongue!

And above all, pay money to a lactation professional who will press all sorts of unnatural interventions on you so you can “naturally” breastfeed.

I’m reminded of the paper by anthropologist Margaret MacDonald in the Lancet entitled The cultural evolution of natural birth:

Natural birth has long held iconic status within midwifery and alternative birth movements around the world that have sought to challenge the dominance of biomedicine and the medicalisation of childbirth…

But there’s is nothing natural about waterbirth, listening the fetal heart with a Pinard stethoscope or recommending chiropractic. Yet midwives do it anyway. Why?

[If an intervention] can bring back the clinical normalcy of the labour pattern and keep it WITHIN THE MIDWIFERY SCOPE OF PRACTICE, it is generally regarded as a good thing by midwives and clients alike … (my emphasis)

The same thing is true about lactation professionals. ANYTHING is acceptable as long as it can keep the women breastfeeding and within lactation consultants’ scope of practice. Lactation professionals have created breastfeeding “emergencies” from which they heroically “save” babies. But most of these emergencies have been caused by lactation professionals themselves with their relentless pressure to breastfeed. They could easily be solved, or avoided altogether, by feeding babies formula.

In truth, the scientific evidence tells us that breastfeeding is a lifestyle choice, NOT a health choice. We know that because breastfeeding rates have no impact on infant mortality and major causes of infant morbidity. We know that because nearly two entire generations of Americans were raised on formula and every possible parameter of infant health improved during that time.

But in their relentless effort to claw market share from formula companies, lactation professionals have medicalized infant feeding by claiming a perfection of breastfeeding that doesn’t exist, medical benefits for breastfeeding that don’t exist, and by creating medical emergencies that they caused.

That’s why we should stop medicalizing infant feeding and return it to its unhindered state. Above all, we must end intrusive breastfeeding promotion in hospitals. It is harming infants’ physical health (exclusive breastfeeding is now the leading cause of newborn hospital readmission) and mothers’ mental health.

Let MOTHERS decide what’s best for babies, their families and themselves, NOT lactation professionals.