Surprise! Vaccinations jump 500% in antivax hotspot amid measles outbreak.

Demand for measles vaccines leapt 500 percent last month in Clark County, Washington—a hotbed for anti-vaccine sentiment that has now become the epicenter of a ferocious measles outbreak.

As of February 6, the county which sits just north of the border from Portland, Oregon—has tallied 50 confirmed cases and 11 suspected cases of measles since January 1. The case count is rising swiftly, with figures more than doubling in just the last two weeks. On January 18, the county declared a public health emergency due to the outbreak.

That’s what happens when the privilege that allows anti-vaxxers to wallow in their delusions disappears.

What do I mean by privilege? It a sign of privilege to live in a society where a disease has been nearly eradicated by vaccination. Indeed, nothing says “privilege” quite like refusing the same vaccines that an impoverished mother in a developing country would trudge five miles to get for her child.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It was fun when they were just immoral freeloaders who exposed other people’s infants and immunocompromised children to injury and death. It’s not fun when their own children face the very same risks.[/pullquote]

No sooner did the privilege disappear — destroyed by anti-vaxxers themselves whose choices have ushered back a deadly public scourge — then the anti-vaxxers folded. It was fun when they were just immoral freeloaders who exposed other people’s infants and immunocompromised children to injury and death. It’s no longer fun when their own children face the very same risk of injury and death they were willing to countenance for other mothers’ children.

Anti-vax is a form privilege in another way. Anti-vax is only possible in a society where most of the parents behave morally and follow the admonition to get their children vaccinated. It’s an example of the ethical conundrum known as the free rider problem.

The classic example is a conservation water ban. People in a town are told not to water their lawns in order to conserve water for drinking. Most people, understanding the importance of having enough water to drink, comply. However, there are always a few people who secretly violate the ban. They believe that they will be protected from a water shortage because everyone else is conserving, and — privileged as they are — they imagine they are entitled to keep their own lawns green.

Free riders are free loaders and they’re unethical.

How do we know? If everyone ignored the water ban the town would run out of water for people to drink and everyone would be harmed. So no matter how much you might want to water your lawn during a water ban, it is unethical to do so. It doesn’t matter that the harm is not immediate, or that no one can draw a direct line between your violation of ban and the lack of water. People who continue to water the lawn during a water ban are stealing an unfair share of a communal good and put the entire community at risk. You have to be remarkably entitled to imagine that you have a right to do that.

When enough people become free riders, the town runs out of water and everyone begins to suffer from thirst. Not surprisingly the unethical people who eagerly wasted water on their lawns stop watering them so they and their families will have enough to drink — just as anti-vaxxers are now rushing to get their children vaccinated. But the damage has been done and the most vulnerable members of the community face the biggest threat.

Similarly most people, understanding the importance herd immunity, vaccinate their children. In contrast anti-vaxxers assume that they will be protected from diseases like measles because everyone else is vaccinating, and — privileged as they are — they imagine they are entitled to keep their own children unvaccinated. But anti-vaxxers have been stealing an unfair share of a communal good (the high level of vaccine induced immunity) and, because of their immoral actions, the entire community is now facing a terrible risk.

In Neoliberal Mothering and Vaccine Refusal: Imagined Gated Communities and the Privilege of Choice Sociologist Jennifer Reich explains how anti-vaxxers leverage their privilege to harm other women’s children:

As privilege facilitates choice, it also potentially jeopardizes the health and well-being of other children who lack resources or whose families are more constrained in their options… [T]hese women’s “choices” about vaccines carry consequences for other women’s families as well.

Anti-vax mothers claim to be empowered by their decision:

Yet, they do so by claiming their power through dominant feminine tropes of maternal expertise over the family and by mobilizing their privilege in the symbolic gated communities in which they live and parent… They also refuse to acknowledge the role their children play in protecting or undermining systems of public health that aim to stave off infections at a community level.

But anti-vaxxers aren’t empowered protectors of their children’s well being. They are ignorant free loaders.

They imagine themselves as having a “right” to behave unethically at the expense of other women’s children … and that’s a remarkably ugly form of privilege.

Advocates of natural mothering have forgotten their most basic natural responsibility.

No, it’s not to have a vaginal birth. No it’s not to breastfeed. No it’s not to pretend to be encouraging bonding by baby-wearing. The PRIMARY purpose of mothers in nature is to make sure their children survive to reproduce. Any time a mother in nature — human or animal — willingly puts her offspring in danger, she is a bad mother.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Any time a mother in nature — human or animal — willingly puts her offspring in danger, she is a bad mother.[/pullquote]

Evolution, as everyone knows, favors SURVIVAL of the fittest. The surrounding environment is always changing but the imperative remains the same. Twenty thousand years ago the best mothers might have ensured their children’s survival by protecting them from predators. Ten thousands years ago the best mothers might have ensured their children’s survival by learning to plant crops. Today the best mothers avail themselves of any and all technology to boost their children’s chance of survival above that of other children.

Keep in mind that what counts is NOT whether mothers believe that their course of action ensures a better chance of survival, it only matters whether their course of action ACTUALLY maximizes their offspring’s chance of survival.

The strength and depth of the maternal imperative to ensure offspring survival is often illustrated by a lioness protecting her cubs. She will put everything on the line, including her own life, to make sure the next generation survives. The animal mother who dismisses a threat instead of reacting to it aggressively is the mother who’s likely to end up an evolutionary failure; she’s a bad mother. It doesn’t matter whether the lioness believes she was right to ignore the threat and it certainly doesn’t matter what the other lionesses think about her decision. After all, she’s in competition with them to give her own cubs a survival advantage; the last thing she should be concerned about is whether the other lionesses approve.

That’s why a good mother is a mother who embraces technology.

Imagine the ancient mother who said: “Fire? OMG, fire is dangerous. People could get burned. There is no way that I am cooking my children’s meat before they eat it!”

She deprived her children of a critical chance for boosting their health, brain power and overall chance of surival. She was a bad mother and her children probably got outcompeted because of it.

Imagine the ancient mother who said, “Deliberately planting seeds in the ground? You have got to be kidding me! How do we know that the seeds we plant will grow into crops as safe and nutritious as the ones we gather? They might be poisoned so we better not eat them.”

She deprived her children of a critical chance for boosting their health, brain power and overall chance of surival. She was a bad mother and her children probably got outcompeted because of it.

Or much, much later:

Imagine the mother who said, ““Electricity? It’s too complicated for me to understand. I’d rather my children and I sit in the dark.”

She, too, deprived her children of a critical chance to boost their survival because she made it impossible for them to enjoy the fruits of modern technology.

That’s why women who choose to freebirth are bad mothers. They value their own experience over their child’s survival. Don’t get me wrong; they have every right to make that choice, but they are bad mothers for choosing anything other than maximizing their child’s survival of the dangerous process of birth.

That’s why women who choose to continue breastfeeding when their babies fail to gain weight and supplement with goats’ milk or homemade “formula” are bad mothers. They may have been led to believe, and they may even believe, that formula is dangerous, but nature doesn’t care what you believe. It rewards the survivors and punishes everyone else.

And that’s why women who refuse to vaccinate are the worst mothers of them all. They are ignorant and fail to understand the science, but it is their children who will be penalized. They are self-absorbed and care more for the accolades of their Facebook peer group than for the wisdom of experts, and it is their children who will pay the price.

Let me make it crystal clear for those who have trouble understanding: If your child is injured or dies from measles because you failed to vaccinate, you are a complete and utter failure as a mother. You failed at your primary purpose, keeping your child alive. It doesn’t matter that in your ignorance your feared vaccine “injuries” more than measles. Measles was the greater threat and you FAILED by being unable or unwilling to appreciate that.

Mothers, you have ONE job that is more important than all others: making sure your children survive to reproduce. Sadly, in 2019, all children will not do so. We are unable to vanquish all threats and you are not responsible if your child dies from something beyond your control. But if there is a way to improve your child’s survival and you refuse to use it so you can preen to your friends that you are a free thinker and a lover of nature — you failed.

That’s why anti-vaxxers are deserving of special scorn. It’s not just because they are ignorant, although they are profoundly ignorant. It’s not just because they are gullible, although they are astoundingly gullible. It’s because they pander and perform for their friends by refusing the technology that will make their children fittest for survival. That’s not merely bad mothering, that’s unnatural.

PT Barnum famously said that you can’t go broke underestimating the intelligence of the American public and pediatrician Dr. Bob Sears demonstrates the truth of that adage every day.

Like Barnum, Sears depends for his income on the gullibility and lack of sophistication of his target audience. Anti-vaxxers are so naive that they seem to have no awareness that anti-vax is a business, and they’ve been duped into buying an endless array of its useless books and products.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Since Dr. Sears’ followers are having trouble seeing anti-vax for the business that it is, let’s give it a nickname: “Bobsanto.”[/pullquote]

Since Dr. Sears’ followers are having trouble seeing anti-vax for the business that it is, perhaps we should identify what he does by giving a nickname to his business. I suggest “Bobsanto.”

Barnum at least had to put on his circus and that costs money. Monsanto at least has to create products that actually do something. “Bobsanto” doesn’t have to create much of anything to rake in the dough. Sears has figured out how to monetize fear, and that’s free, especially when you create it yourself.

I could spend a lot of time debunking Sears’ claims and insinuations one by one, but I know that’s not very effective, because anti-vaxxers lack the knowledge of immunology needed to understand them in the first place. But even those who never learned chemistry should have learned cynicism though. They should be able to recognize a marketing ploy when they see one.

“Bobsanto” is no more committed to your health and wellbeing than Monsanto is. Both are businesses that make money by promoting and selling products. Monstanto sells a range of products some of which have tremendous value, some of which have serious side effects and all of which fill Monsanto’s coffers.

“Bobsanto” is part of the Sears’ family business, involving his father and siblings, that promotes and sells a range of products all of which have no intrinsic value since don’t do anything besides line the Sears’ pockets. They only have value when you’ve been convinced to fear the less expensive, often far more effective, conventional alternative. That’s where Sears’ and his family members’ true brilliance comes in. They know that their claims don’t have to make sense and don’t even have to be true. They are fluent in the language of both performative motherhood and faux “empowerment” that deluded anti-vaxxers think they are mastering.

Bob Sears provides emotional support by sharing fears about vaccines and by affirming mothers’ right to assign her own unique beliefs to vaccines. This service fills is a critical social need in the context of anti-vax advocacy that depends on a shared cultural consensus for its significance. And he and his family charge a bundle for it.

Monstanto at least gives you a product. Bobsanto merely offers nonsense with a heaping side of self-pity. Dr. Bob imagines portrays himself as persecuted because he has been placed on probabation for violating the standards of medical practice.

Don’t worry, though. Dr. Bob won’t change. He isn’t about to let the his various income streams dry up.

Nothing has changed about the way I practice. I won’t pretend this whole ordeal isn’t stressful. It is. But it has also prompted me to increase my focus and involvement in what really matters to me in this world — giving each and every family I meet complete, objective, and un-doctored informed consent on the topic of vaccination.

What led to his “ordeal”? A recent article in JAMA explains:

The case against Sears, a popular and highly visible California pediatrician known for inventing an alternative vaccine schedule, arose from the 2014 care of a 2-year-old patient. The boy’s mother told Sears that, after previous vaccinations, the boy was unable to defecate or urinate for 24 hours and he went limp “like a ragdoll.” Sears did not take a detailed vaccine-associated history but wrote the boy a medical exemption from all future vaccinations, declaring that his kidneys and intestines had shut down and he had had a so-called severe encephalitis reaction caused by prior vaccinations.

The complaint against him alleged:

…gross negligence, repeated negligent acts in his care for a patient, and failure to maintain appropriate records.

Sears AGREED with all the charges leveled against him so he could continue monetizing the fear he cultivates so assiduously.

Sears can continue practicing medicine but will be required to take an ethics class and 40 hours of medical education courses a year and be monitored by a fellow physician. He also must notify all hospital and medical facilities where he practices about the order …

I suspect it’s going to be a lot harder to get a vaccine exemption from Dr. Sears for the foreseeable future.

Not matter. Anti-vaxxers are utterly oblivious to the fact that Bobsanto, like Monsanto, is an enterprise that exists to create value and profit for its shareholders regardless of whether its products help or harm people.

Proving once again that you can’t go broke by underestimating the intelligence of the American anti-vaxxer.

There’s a simple thing that every mother can do to keep her baby as healthy as possible. That’s why we should have a ten step hospital based program to support it.

No, it’s not breastfeeding; it’s vaccination, which saves a thousand times more lives in practice than breastfeeding ever could in theory.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]All mothers would vaccinate if only they got the proper education and support.[/pullquote]

Therefore, it is a thousand times more important to promote vaccination than to promote breastfeeding. No mother would refuse to do it if she only understood the benefits and got the proper support. That’s why I propose an immediate overhaul of the Baby Friendly Hospital Initiative to promote vaccination instead of breastfeeding.

The Ten Steps to Successful Vaccination are:

1. Have a written vaccination policy that is routinely communicated to all health care staff.
2. Train all health care staff in the skills necessary to implement this policy.
3. Inform all pregnant women about the benefits of vaccination.
4. Insist that every mother sign a vaccine contract that emphasizes that anything other than full vaccination on the CDC schedule threatens baby’s health.
5. Mandate frequent visits by a vaccination consultant to provide constant support for vaccination.
6. Help mothers initiate all recommended injections within one hour of birth.
7. Show mothers how to obtain vaccinations even if they are separated from their infants.
8. Accept no refusal to vaccinate unless medically indicated.
9. Encourage vaccination on demand by the pediatrician.
10. Foster the establishment of vaccination support groups and refer mothers to them on discharge from the hospital or birth center.

Wait, what? Some mothers think there are legitimate reasons not to vaccinate their babies? There are no legitimate reasons; it’s just a sign that they haven’t received enough vaccination support from hospital personnel, their peers and society at large.

Wait, what? Some mothers think that vaccination harms their infants? Who cares what they think? Public health officials have spoken on the issue of vaccination and mother’s observations of their own infants are irrelevant.

Wait, what? Some mothers think this is an issue of personal freedom? It most certainly is not. Vaccinating a child does not simply protect that child, but it provides a measurable benefit to society.

Lack of peer support for vaccination is a serious problem in and of itself. There are webpages and Facebook groups that encourage parents not to vaccinate or to diverge from the CDC schedule. Such webpages and Facebook groups must be ruthlessly suppressed along with public shaming of anyone who doesn’t support routine childhood vaccination.

Let’s face it: those who vaccinate according to the CDC schedule love their children more than those who do not. Only a lazy, selfish mother would listen to anti-vaccine quacks instead of the CDC.

I even have a motto for the NEW Baby Friendly Hospital Initiative:

Breastfed Is Good,
Fed Is Better, but
Vaccinated is BEST!

Why waste time promoting breastfeeding when we could be promoting vaccination and saving far more lives?

Hi, there! It’s Ima Frawde, CPM (certified professional misogynist) here to describe the newest trend in marriage: natural wifing.

Now that natural childbirth, lactivism and attachment parenting have reduced women to the slaves of children under the guise of copying our foremothers, we feel it is time to crush any remaining independence of women with natural wifing. After all, that’s how domestic relationships have been conducted throughout most of human evolution.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Just as mothers exist only to do what’s best for babies, wives exist only to do what’s best for husbands.[/perfectpullquote]

How do we define natural wifing? It has three major components:

1. Husband-led Sex

Shocked? You shouldn’t be. Nature designed women to serve as sex objects and for the sexual comfort of men. Ladies: no matter when he wants it, where he wants it, and how he wants it, you OWE him sex. His health depends upon it! Studies show that sex has a myriad of health benefits and it would be lazy and selfish of you to deprive your husband of those benefits.

Are you ever allowed to say no to your husband’s demands for sex? Sure you can say it, but he knows you really want it. Natural wives are empowered by assault, just like our ancient foremothers.

Birth control — a form of patriarchal technology, every bit as dangerous as epidurals — is not allowed. Since the evolutionarily fittest males are those with the most offspring, women should be impregnated as often as possible. Contraception of any kind would interfere with a man’s biological imperative.

Moreover, we know that authentic women are empowered by repetitive pregnancies. And don’t forget the health benefits to you! Just think of how many pesky menstrual periods you will avoid.

2. No work outside the home and no technology within it.

Natural wifing is “green” and therefore incompatible with modern appliances that deprive women of the authentic experiences of using their body parts to serve their husbands. Hands can be used to grind the flour, knead the bread and otherwise prepare meals. Feet can be used to pound the clothes while washing them in a local stream or pond and for crushing the grapes used in homemade wine.

Yes, it’s true that natural wifing involves painful, exhausting, back breaking labor, but as in the case of childbirth: women who abolish the pain have husbands who may fail to bond to them. Natural wives know that the pain of domestic drudgery is empowering!

As a bonus, natural wifing means that you and your family will be completely prepared to survive a nuclear apocalypse in exactly the same way as homebirth advocates and lactivists are!

Natural wives are not literally restricted to the inside of the home. They are free to search for nuts and berries for example as long as they baby-wear their infants while doing it. But no woman is allowed to go on a hunt, protect the tribe from attack, fabricate tools or create art. Those are male pursuits and any woman who wants to participate is unnatural by definition.

Therefore, there’s no need to educate female children beyond the rudiments of reading and basic arithmetic since they should never work outside the home and their talents should be surpressed or at least deeply discouraged.

3. Animals serve as role models for domestic relationships.

The goal of natural childbirth and breastfeeding is to copy animal mothering as closely as possible, so the goal of natural wifing should be to copy animal relationships as closely as possible. Obviously, a natural wife is part of a harem. Throughout the animal kingdom, alpha males maintain harems of females whom they impregnate on a regular basis. The males are free to mate with as many females as possible, while the females are restricted to the alpha male. Should she stray, she can be beaten and her children by another male can be killed.

Male primary relationships are with other males. Husband doesn’t spend time at home with you and he ignores your children? Why should he do otherwise? Do male bears, lions and gorillas engage in domestic chores? No, they do not! Do they care for offspring? No, again. Natural wives know better than to expect men to behave any differently from animals.

Do these three principles leave natural wifing advocates open to charges of misogyny? No more and no less than natural mothering. Furthermore, we embrace the charge. Misogyny is a fundamental principle within the animal kingdom and we are all about using animals as our role models.

Toward that end we plan to humiliate and shame any wives who refuse to follow the principles of natural wifing. Just as mothers exist only to do what’s best for babies, wives exist only to do what’s best for husbands. That’s why the Husband Friendly Hospital Initiative — designed to support women in simultaneously practicing natural mothering and natural wifing — is coming to a maternity facility near you!

David Foster Wallace gave the 2005 Commencement speech at Kenyon College. He started with a parable:

There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says “Morning, boys. How’s the water?”

And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes “What the hell is water?”

He explained:

The point of the fish story is merely that the most obvious, important realities are often the ones that are hardest to see and talk about.

I’m an old fish!

I can see, in a way many younger people cannot, that the current parenting reality — the water in which we swim — is natural mothering ideology. And I remember when it wasn’t.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]French women aren’t pressured to breastfeed; breastfeeding rates are low and their children are as healthy or healthier than ours.[/pullquote]

Anglo-American parenting experts are currently obsessed with what they imagine to be a recapitulation of motherhood prior to the advent of technology. As part of that, they are obsessed with breastfeeding rates. To make sure that everyone else is equally obsessed with breastfeeding, they have massively exaggerated the benefits, ignored the risks, and elided its physical and psychological toll on women.

But natural mothering ideology is just one parenting ideology among many. It isn’t the truth as most people who ever lived and most people who live now could tell us … if we would listen.

As I’ve pointed out many times, the fact that are ancient foremothers had no formula meant that their babies died if they couldn’t make enough breastmilk. It is no problem from a population standpoint if up to 15% of new mothers can’t produce enough milk, just like it is no problem from a population standpoint if 20% of pregnancies naturally end in miscarriage (as they do).

And I’ve pointed out many times that two entire generations of American were raised on formula nearly exclusively. According to lactation professionals’ predictions that formula leads to an increase in infant deaths, health problems and healthcare expenditures we should have seen a massive increase in all three. Instead infant mortality dropped, infant morbidity dropped, and pediatric healthcare expenditures rose no faster than the rest of healthcare spending.

But there’s another instructive example closer to hand. French women aren’t pressured to breastfeed; their breastfeeding rates are low and their children are as healthy or healthier than ours.

Why don’t many French women breastfeed?

Data from Paris-based think tank OECD show the percentage of babies who’ve ever been breastfed–even for a day– was above 95 percent in Norway, Denmark and Sweden. While the United States and the United Kingdom topped 75 percent.

The data put the number of French kids ever breastfed at some 62 percent.

“France is not only the European country where the breastfeeding rate is one of the lowest but it’s also one of the countries where mothers chose to breastfeed their child the least time possible,” the institute wrote in an article that appeared with the numbers.

Why such a low rate?

The “Leche League France”, a breastfeeding support organization, said the reasons are historical and also tied to a curious strain of French feminism.

“There is a significant movement in French society which says breastfeeding is tantamount to slavery and exploitation. So to promote breastfeeding is to be against women’s liberation,” Leche League spokeswoman Claude-Suzanne Didierjean-Jouveau told The Local on Tuesday.

“This brand of French feminism renounces breastfeeding because they consider motherhood slavery for women.”

Feminist French philosopher Elisabeth Badinter wrote an entire book on the topic, Conflict: The Woman and The Mother.

…[Badinter] contends that the politics of the last 40 years have produced three trends that have affected the concept of motherhood, and, consequently, women’s independence. … “[E]cology” and the desire to return to simpler times; second, a behavioral science based on ethology, the study of animal behavior; and last, an “essentialist” feminism, which praises breastfeeding and the experience of natural childbirth, while disparaging drugs and artificial hormones, like epidurals and birth control pills.
All three trends, Ms. Badinter writes, “boast about bringing happiness and wisdom to women, mothers, family, society and all of humankind.” But they also create enormous guilt in a woman who can’t live up to a false ideal…

Ms. Badinter … says that the baby has now become “the best ally of masculine domination.”

Badinter decries a philosophy that effectively relegates a woman to the home, sacrificing her health, independence and autonomy in an effort to live up to a socially constructed ideal:

… The “green” mother, she says, is pushed to give birth at home, to refuse an epidural as the reflection of “a degenerated industrial civilization” that would deprive her of “an irreplaceable experience,” to breast-feed for both ethological and environmental reasons (plastic baby bottles) and to use washable rather than disposable diapers — in other words, to discard the inventions “that have liberated women.”

Sound familiar? It’s the ethos aggressively promoted by midwives and lactation consultants in the US and UK. According to them, a country like France, where women reject the very notion that unmedicated birth and breastfeeding important and worth pursuing, should be a hell-hole of pediatric tragedy.

But it’s not.

Voila!

How does that compare with the UK where pressure to breastfeed is so intense that Half of Women Who Struggle to Breastfeed Feel Like Failures?

Or how about the US where there has been widespread adoption of the Baby Friendly Hospital Initiative with a concomitant increase in newborn complications like dehydration, severe jaundice, brain injury and death? Indeed, exclusive breastfeeding is now the leading risk factor for newborn hospital readmission; literally tens of thousands of babies are being readmitted each year at a cost of hundreds of millions of dollars.

Compare the three countries and it’s easy to see that breastfeeding has no impact at all. The country with the best outcomes for infants is France, which has the lowest breastfeeding rates and the least amount of pressure to breastfeed.

The French can teach us a lot about the Anglo-American obsession with breastfeeding. Our obsession with breastfeeding reflects the culture in which we live, not what is good for either babies or mothers.

Our obsession with breastfeeding is a result of multiple different trends including the monetization of breastfeeding by lactation professionals, a popular trend to create ever more work for mothers, and a fear within the larger culture of women’s legal and professional emancipation.

We can be sure, however, that it has nothing to do with babies’ health no matter how strenuously lactational professionals insist it does. Look again at the graphs above. Who benefits from aggressive promotion of breastfeeding? It isn’t babies and it certainly isn’t mothers who are encouraged to sacrifice their physical and mental health in order to breastfeed.

Take it from an old fish: your baby doesn’t care whether or not you breastfeed!

Could lactation professionals possibly get more self-absorbed and clueless?

Every time I think they’ve reached the nadir, they show they are perfectly capable of a sinking lower. That’s my reaction after reading an editorial in this month’s issue of Breastfeeding Medicine, Primum Non Nocere Breastfeeding.

Primum non nocere is translated as “first do no harm” or “above all, do no harm”. It’s an elliptical sentence in that the last few words are implied but missing: Above all, do no harm to PATIENTS!

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The Academy of Breastfeeding Medicine seems to think that the only part of mothers worth protecting is their breasts, not their lives.[/pullquote]

Primum non nocere is closely related to two of the four cardinal principles of medical ethics: beneficence and non-maleficience (the other two being autonomy and justice).

The primary ethical principle that forms the foundation for medical care (and the foundation of every society throughout history) is the concept of beneficence — the obligation to do good for others. The ability to do good is also the obligation to do good.

But:

The desire to do good often compels health care practitioners to perform some action in virtually any clinical situation, regardless of its effectiveness or even lack thereof. It is a reflection of our training, if not our DNA… [C]ountless studies around the world have demonstrated that physicians and the public perceive the benefits of almost every treatment to be far greater and the risks substantially lower than they really are. There is a biased belief in the good that will be done…

That’s why it is so important to give priority to doing no harm. It acts as a brake on our impulse to do something.

This is especially critical in preventive medicine when patients are healthy and all but a small subset are likely to remain healthy.

Preventing illness and screening for disease (or potential disease) in asymptomatic people is now considered an imperative. The benefit of various preventive measures, and the perceived absence of risk of testing and treatment (e.g., from screening tests such as prostate-specific antigen and mammography, or from statin therapy) are likewise far from reality.

When I saw that the editorial included “primum non nocere” in the title, I assumed that the author would be addressing the harms caused by aggressive breastfeeding promotion in general and the Baby Friendly Hospital Initiative in particular. I couldn’t have been more wrong. The author Timothy J. Tobolic, MD, President of the Academy of Breastfeeding Medicine, is concerned with preventing harm to breastfeeding, NOT preventing harm to babies and mothers.

In my view, it is a fundamental violation of medical ethics to place protecting a process above protecting patients. NOTHING comes before the wellbeing of our patients.

Wait, I hear you say. By promoting breastfeeding, which is good for babies and mothers, we are promoting the wellbeing of our patients.

That attitude is typical of the paternalism and egotism so beloved of physicians — Doctor knows best! — and so despised by patients. The history of medicine is littered with examples of doctors causing harm by believing in the tests, medications and treatments they promoted. Diethylstilbestrol (DES) was prescribed by doctors who believed they were doing good, episiotomies became routine because doctors were sure they were doing good. You would think we would have learned some humility by now, but apparently not.

But, wait, I hear you say. Breastfeeding is natural; it must be better than any technological alternative.

Wrong! Natural immunity, so beloved of anti-vaxxers, is far inferior to vaccine induced preventive immunity. Just because something is natural doesn’t mean we should reflexively support it. We should apply the same ethical principles to the natural as to any other medical recommendation.

I naively thought Primum Non Nocere Breastfeeding would be about reducing the rising rate of newborn dehydration, addressing the fact that 90% of cases of kernicterus (jaundice induced brain damage) are caused by breastfeeding, the reacting to the fact that exclusive breastfeeding is the leading risk factor for newborn hospital readmissions accounting for literally tens of thousands of newborn readmissions each year at a cost of hundreds of millions of dollars.

Silly me! The brain injuries, suffering, deaths and massive expenditure of healthcare dollars both to promote breastfeeding and to treat the complications caused by promoting breastfeeding don’t even rate a mention by Dr. Tobolic. He doesn’t seem particularly interested in protecting patients; he wants to protect breastfeeding!

I find some of his recommendations nauseating, as well as deeply unethical.

He seems to think epidurals pose a risk to breastfeeding:

Epidural anesthesia has revolutionized pain control during labor. However, there remains inadequate information and education of mothers on the potential harms that epidurals can have on breastfeeding. As recommended by ABM Clinical Protocol #15, Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017, more studies need to be done on safety of analgesics used in deliveries and their impact on breastfeeding. Reliable safety information must be developed for the education of mothers.

There is NO EVIDENCE that epidurals interfere with breastfeeding in any way, but no matter. Apparently the theoretical risk of epidurals to breastfeeding is more important than the REAL risks of breastfeeding promotion like newborn readmissions, brain injuries and deaths.

The amount of nonsense in his piece is truly mind boggling. This is what he writes about the “Golden Hour.”

I had many opportunities to have a student or resident present at a delivery. I would challenge them to observe, both during and after the delivery, the activities that disrupt or encourage breastfeeding and watch the magic of newborn self-attachment. Few took me up on this valuable education and I believe must be promoted as a necessary part of medical education.

Newborn attachment does NOT take place at birth; it is a SPONTANEOUS process that occurs over time and has NOTHING to do with breastfeeding. Successful extended breastfeeding is NOT dependent on that first hour. There are indigenous cultures in which mothers do not offer the breast for the first few days and substitute prelacteal feeds instead. And what about an opportunity for the mother to recover from the exhaustion and agony of childbirth in the first hour? Who cares about the mother?

Some of the nonsense is deadly:

The automated blood pressure monitor continuously attached to the mother especially after delivery can be disruptive to trying to get the baby latched. I personally have removed them to allow the mother to get in a better position to hold the baby. It is an annoyance that could be done intermittently and not for staff convenience.

Perhaps Dr. Tobolic has failed to notice that the US is experiencing a crisis in maternal mortality. Pehaps he fails to understand that one of the factors responsible for the crisis is failure to recognize and treat hypertensive disease of pregnancy PARTICULARLY after birth. Blood pressure monitoring is crucial to protecting mothers, but Dr. Tobolic and the Academy of Breastfeeding Medicine seem to think that the only part of mothers worth protecting is their breasts, not their lives.

Dr. Tobolic’s opinion piece is an ethical travesty. The fact that he could write it and publish it is symptomatic of the unethical nature of contemporary breastfeeding promotion. Women are more than their breasts. Their pain counts; their suffering counts; their lives matter more than whether or not they breastfeeding! Babies are more than mouths. Their pain counts; their suffering counts; their lives matter more than whether or not they breastfeed!

The American Academy of Breastfeeding should be ashamed that they have lost the plot so thoroughly that they actually think promoting breastfeeding is more important than whether mothers and babies live or die. But in their supreme self-absorption and cluelessness, they are probably patting themselves on the back instead.

I wrote a piece that appeared on Slate on Friday. Will the Tide Ever Turn on Breastfeeding? highlights the fact that most of the promised benefits of breastfeeding have never appeared. Worse, aggressive breastfeeding promotion is harmful.

There has been an increase in babies falling from their mothers’ hospital beds or suffocating [due to forced rooming in]. There has been a rise in serious harms to babies including dehydration, starvation, brain injuries, and even deaths. Indeed, exclusive breastfeeding on discharge is now the leading risk factor for hospital re-admission.

Nearly all the pain, suffering and death can be traced to the Ten Steps of the Baby Friendly Hospital Iniative. How could lactation professionals, good people with good intentions, turn out to be so wrong? As I explained in the Slate piece, health recommendations were issued on the basis of small studies without waiting for confirmation by larger studies. Most of these early studies have been debunked. Moreover, small studies, by their very nature, cannot reveal the risks that become serious problems in large population.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]When a measure becomes a target, it ceases to be a good measure.[/pullquote]

The tragedy of the Baby Friendly Hospital Initiative is that a program designed to improve babies’ health has harmed them instead; tens of thousands of newborns are readmitted to the hospital each year for dehydration and jaundice. Equally tragic, a program designed to support mothers has ended up undermining their psychological health.

Why? The answer can be found in data science: Goodhart’s Law.

When a measure becomes a target, it ceases to be a good measure.

Campbell’s Law, a corollary of Goodhart’s Law, is equally instructive:

The more any quantitative social indicator is used for social decision-making, the more subject it will be to corruption pressures and the more apt it will be to distort and corrupt the social processes it is intended to monitor.

What does that mean?

Incentive structures work,” as Steve Jobs put it. “So you have to be very careful of what you incent people to do, because various incentive structures create all sorts of consequences that you can’t anticipate.” Sam Altman, president of Y Combinator, echoes Jobs’s words of caution: “It really is true that the company will build whatever the CEO decides to measure.”

This sketch from the fantastic website Sketchplanations illustrates the problem:

Imagine you are the CEO of a company that manufactures nails and you want to incentivize your workforce to increase profits by rewarding them for meeting production targets.

If you tell them you will offer a bonus to workers who meet a target number of nails produced each week, workers will start making tiny nails so they can produce more of them. If instead you offer a bonus to workers who meet a target for weight of nails produced each week, workers will switch to producing a few massive nails. When a measure becomes a target, it ceases to be a good measure because setting a target distorts and corrupts the process it is designed to monitor.

What should the CEO of the nail factory have chosen to measure?

Data scientist Roman Shraga offers this answer:

You need to ask questions that ensure the measure relate [sic] to the ultimate goal. Additionally, think about whether it would be possible to get a perfect score on the measure, and if it would be possible, to do so without adding any value. This line of reasoning will allow you dissect a measure until you understand whether or not it is doing a good job of indicating performance.

In other words, the CEO should have chosen a measure, or a combination of measures that increases productivity without compromising quality.

Now let’s look at the Baby Friendly Hospital Initiative. Its leaders chose to incentivize hospitals, nurses and lactation consultants on exclusive breastfeeding rates at discharge. That seemed like a good target to choose because the goal was to increase long term exclusive breastfeeding rates and the mothers who breastfeed exclusively for the long term are likely to be exclusively breastfeeding at discharge. In addition, it is much easier to measure exclusive breastfeeding rates at discharge than to track down mothers and babies to see if they are breastfeeding 3, 6 or 12 months later.

How has this target distorted and corrupted the provision of breastfeeding support to new mothers? Just look at the Ten Steps:

Since hospitals, nurses and lactation consultants want to maximize the rate of exclusive breastfeeding at discharge, the Ten Steps make it nearly impossible to avoid breastfeeding. Mothers are hectored to breastfeed, forced to breastfeed within the first hour, denied formula, forced to endure the baby’s cries of hunger by rooming in, and denied pacifiers that might soothe the baby.

When lactation consultants are incentivized to maximize rates of exclusive breastfeeding at discharge, they ignore dehydration, hypoglycemia (low blood sugar) and jaundice because treating them would involve formula and that would reduce the rate of exclusive breastfeeding.

When lactation consultants are incentivized to maximize rates of exclusive breastfeeding at discharge, they make formula hard to get: they restrict access to it, lock it up and force women to sign odious, shaming “consent forms” to get it.

When lactation consultants are incentivized to maximize rates of exclusive breastfeeding at discharge they make sure that hospital personnel will not have to endure the anguished cries of starving infants by closing well baby nurses and leaving babies in mother’s rooms around the clock. And should nurses break down because of simple human compassion and offer formula, they are excoriated by official policy.

Is it any wonder then that exclusive breastfeeding has become the leading risk factor for hospital readmission? By setting the wrong target, the BFHI incentivizes poor, even deadly, care.

What should breastfeeding promotion incentivize?

Since our goal ought to be providing breastfeeding support for anyone who wishes to breastfeed:

1. Mothers’ desires must be accommodated, instead of ignored as they are now.

2. The quality, availability and accessibility of SUPPORT should be measured not the absolute number of infants breastfeeding exclusively.

3. Hospital readmissions must be measured since any effort to promote breastfeeding that leads to an increase in dehydration, hypoglycemia and jaundice is a failure regardless of how high the rate of exclusive breastfeeding at discharge might be.

4. Formula should be easily available; women should be taught how to use it; and judicious formula supplementation should be freely recommended in the early days when babies are most likely to suffer breastfeeding complications.

5. The only breastfeeding rates that are clinically relevant are rates beyond two months. That’s much harder to measure but that’s what actually matters. Measuring exclusive breastfeeding rates on discharge reflects the streetlight effect, also known as the drunkard’s search principle: searching for keys lost in a unlit park under a streetlight because that where it is easiest to look.

The tragedy of the Baby Friendly Hospital Initiative is that bad outcomes were nearly guaranteed by focusing on the wrong target … and failing to understand Goodhart’s Law: when a measure becomes a target, it ceases to be a good measure.

Why are natural childbirth and breastfeeding advocates relentlessly looking for a physical cause for a mental health problem?

As part of their ongoing effort to demonize both C-sections and formula feeding, they seem desperate to show that mode of birth or “failure” to breastfeed are risk factors for postpartum depression. But why would anyone think that a mental health problem had a physical cause? And wouldn’t the best place to look for risk factors for a serious mental health problem be psychological issues?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Women who were psychologically flexible and able to be compassionate to themselves were at lower risk of postpartum depression.[/pullquote]

According to a 2016 review in the New England Journal of Medicine:

…Symptoms of postpartum depression often include sleep disturbance (beyond that associated with the care of the baby), anxiety, irritability, and a feeling of being overwhelmed, as well as an obsessional preoccupation with the baby’s health and feeding. Suicidal ideation and worries about causing harm to the baby have also been reported. The strongest risk factor for postpartum depression is a history of mood and anxiety problems and, in particular, untreated depression and anxiety during pregnancy.

We already know factors that impact mental health play an important role:

…including low social support, marital difficulties, violence involving the intimate partner, previous abuse, and negative life events.

“Wait,” I hear natural mothering advocates cry, “what about hormones?”

The rapid decline in the level of reproductive hormones after childbirth probably contributes to the development of depression in susceptible women, although the specific pathogenesis of postpartum depression is unknown.

The impact is serious:

Postpartum depression results in maternal suffering and diminished functioning and is asso- ciated with increased risks of marital conflict and impaired infant–caregiver attachment, as well as increased risks of impaired emotional, social, and cognitive development in the child, and in rare cases, suicide or infanticide.

Given the high incidence, serious nature and profound effects of postpartum depression, we should be doing everything we can to prevent it. A new paper to be published in the March issue of the Journal of Affective Disorders asks the critical question, What protects at-risk postpartum women from developing depressive and anxiety symptoms?

The authors describe the problem:

The adjustment to motherhood is marked by a range of different internal experiences, including negative thoughts and emotions. However, societal ideologies highlight that a normative response to motherhood is the presence of immediate and continuous feelings of happiness and joy. These expectations of motherhood may lead to women having more difficulties accepting their internal experiences, such as negative thoughts and emotions, when they do not reflect such ideals…

They found:

Women not presenting depressive and anxiety symptoms reported significantly higher levels of psychological flexibility, nonjudgmental appraisal of thought content and self-compassion than women presenting depressive and anxiety symptoms. Hierarchical logistic regression showed that women with higher levels of psychological flexibility (OR = 1.06, CI: 1.01–1.12) and nonjudgmental appraisal of thought content (OR = 1.33, CI: 1.15–1.53) had a significantly higher likelihood of not presenting depressive and anxiety symptoms.

They explain:

Consistent with previous studies, our results showed that women presenting no depressive and anxiety symptoms reported significantly higher levels of psychological flexibility, nonjudgmental appraisal of thought content and self-compassion when compared with women presenting depressive and anxiety symptoms. We also found a significant negative association between these variables and depressive and anxiety symptoms… Thus, these findings corroborate our hypothesis that a more accepting and self-compassionate attitude towards private events in the postpartum period for women presenting a risk for PPD is associated with lower levels of depressive and anxiety symptoms.

Women who were psychologically flexible and able to be compassionate to themselves were at lower risk of postpartum depression. Unfortunately we live in the milieu of natural mothering ideology that is psychologically rigid and so far from compassionate as to be cruel:

…[T]he social idealization of motherhood can hinder the acceptance of negative private thoughts and emotions during this period and lead to maladaptive avoidance strategies, which have a significant impact on the psychological adjustment of postpartum women…

The authors conclude:

Our results suggest that a tendency to be more accepting and nonjudgmental of internal experiences might be beneficial and that promoting this tendency could be an important feature of perinatal psychological prevention interventions…

That’s why, for example, the insistence of lactation professionals that breastfeeding reduces the risk of postpartum depression is such an egregious lie.

It is a lie because we know that the risk of postpartum depression depends on intention to breastfeed not on the process of breastfeeding itself.

New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women’s Intentions found:

…[T]he effect of breastfeeding on maternal depression symptoms was found to be highly heterogeneous and, crucially, mediated by breastfeeding intentions during pregnancy. Our most important finding relates to the majority of mothers who were not depressed during pregnancy, and who planned to breastfeed their babies. For these mothers, breastfeeding as planned decreased the risks of PPD, while not being able to breastfeed as planned increased the risks.

Furthermore:

For the majority of mothers who did not show symptoms of depression before birth, breastfeeding … increased the risk of PPD among mothers who had not intended to breastfeed.

When women could not meet their own goal of breastfeeding, the risk of postpartum depression doubled. And the exact same thing happened when women who did not want to breastfeed were pressured to do so even when they were able to successfully breastfeed. If breastfeeding itself were protective, that would not have happened.

The claim that of lactation professionals that breastfeeding prevents postpartum depression is a particularly heartless lie for two reasons. First, they are the ones who have exaggerated the benefits of breastfeeding out of all proportion to reality. Because of their claims of (mostly debunked) benefits, women pressure themselves to breastfeed. Second, when these women have trouble, either because of insufficient breastmilk, pain or other cause, lactation professionals refuse to demonstrate psychological flexibility or compassion.

The bottom line is that while postpartum depression may have physical components, nearly all risk factors are psychological. If lactation professionals cared about women (as opposed to breastfeeding rates) they would stop lecturing, hectoring and shaming them. I’m not holding my breath that will happen anytime soon!

Every time I read the term ‘mother-baby dyad’ I cringe.

Inevitably what follows is an admonition to the mother or her providers to sacrifice her needs, desires and comfort for the “good” of the baby. The mother-baby dyad is used to justify forcing women to room in with their infants in hospitals, the closing of well baby nurseries, the practice of baby-wearing and the rest of the ritualized behaviors that are so beloved of attachment parenting aficionados.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]AP advocates have edited out Bowlby’s concern with the wellbeing of mothers to subvert Attachment Theory into attachment parenting.[/pullquote]

But providers — I’m looking at you midwives and lactation consultants — have subverted the meaning of the mother-baby dyad for their own ends. In truth, the relationship is bi-directional and the needs and comfort of both parties must be taken into consideration.

That’s what John Bowlby, the father of Attachment Theory, explained:

To grow up mentally healthy, “the infant and young child should experience a warm, intimate, and continuous relationship with his mother (or permanent mother SUBSTITUTE) in which BOTH find satisfaction and enjoyment (my emphasis)

As psychologist Inge Bretherton has noted:

Later summaries often overlook the reference to the substitute mother and to the partners’ mutual enjoyment.

That’s an understatment!

AP advocates have edited out those two phrases to subvert Attachment Theory into attachment parenting. The result is to mandate specific behaviors on the part of the mother and to ignore any concern for her wellbeing. The defining features of attachment parenting are constant physical proximity and constant maternal sacrifice. According to Bowlby, in contrast, neither is necessary or even good.

From the inception of Attachment Theory, Bowlby acknowledged that the mother herself was not required; a substitute is perfectly acceptable. To grow up mentally healthy, children need a long term caregiver they can depend upon. That person can be a father, a grandparent or a hired nanny. The child needs someone to be physically present on an ongoing basis, but that someone doesn’t have to be a female parent. Hence the notion of the mother-baby dyad is fundamentally flawed.

Since the caregiver doesn’t have to be the mother, or even a woman, all the admonitions around childbirth and breastfeeding have nothing to do with Attachment Theory. A baby doesn’t need his mother to suffer through labor without pain relief in order to bond with the caregiver; he doesn’t need skin-to-skin contact; he doesn’t need breastfeeding. Those things were added in by Dr. Sears to promote his religious philosophy that women are subservient to men and should stay home and care for children.

The key characteristics of the caregiver are emotional warmth and ongoing presence. What happens at birth and in the early hours after birth are irrelevant. Any adoptive parent could tell you that. It’s also what any mother who gave birth with an epidural, didn’t practice skin-to-skin, and didn’t breastfeed can tell you. The baby forms it first bond with whomever cares for it on an ongoing basis and the bond happens spontaneously without ritualized behaviors.

It’s hard to overemphasize the importance of this fact. Almost every admonition of attachment parenting rests on the belief that the mother is needed uniquely and the baby’s health psychological development must therefore depend on things — like vaginal birth and breastfeeding — that only a biological mother can do. Attachment Theory tells us otherwise.

Equally, it’s hard to overemphasize that fact that maternal sacrifice is not required to ensure a child’s healthy psychological development. Indeed, healthy development requires the satisfaction and enjoyment of the mother as well as the child.

So where did we get the idea that maternal sacrifice is integral to child development? We have been socialized to believe it because of the misogyny in historical and contemporary culture. As I noted recently, sociologist Pam Lowe explains in Reproductive Health and Maternal Sacrifice:

…At its heart, maternal sacrifice is the notion that ‘proper’ women put the welfare of children, whether born, in utero, or not yet conceived, over and above any choices and/or desires of their own. The idea of maternal sacrifice acts as a powerful signifier in judging women’s behaviour…

Babies don’t require maternal sacrifice; other adults do.

But sacrifice isn’t merely unnecessary, it can be actively harmful. Or as an unknown philosopher, almost certainly female, once said: “If mama ain’t happy, ain’t nobody happy!”

• Babies don’t need and don’t benefit from mothers enduring agonizing childbirth pain.
• Babies don’t need and don’t benefit from mothers being forced or forcing themselves to breastfeed.
• Babies don’t need and don’t benefit from mothers being pressured to stay home full time.
• Babies don’t need and don’t benefit from enforced physical proximity with their mothers if that’s not what their mothers enjoy.
• Babies don’t need and don’t benefit from sharing the mother’s bed or room if that interferes with the mother’s sleep.

Attachment parenting advocates — lactivists in particular — have spent years attempting to normalize mothers’ pain, exhaustion and mental suffering by lying to them about what babies truly need. Attachment Theory teaches us the opposite. The mother is equally important as the baby in the mother-baby dyad and we must stop pretending maternal sacrifice is required.