NPR recently published a chilling piece.

She Wanted To Be The Perfect Mom, Then Landed In A Psychiatric Unit details the horrifying experience of a woman who suffered from postpartum psychosis.

Lisa wanted to be the perfect mom. She was ready to be the perfect mom. She and her husband lived in San Francisco, and Lisa had worked as a successful entrepreneur and as a marketing executive for a Silicon Valley tech company. When it came to starting her family, she was organized and ready to go. And that first week after her baby was born, everything was going according to plan. The world was nothing but love.

Then the baby started losing weight, and the pediatrician told Lisa to feed her every two hours.

Lisa started to feel like she couldn’t keep up.

“It weighed on me as, ‘I’ve failed as a mom. I can’t feed my child,’ ” she says. “I needed to feed her — that was the most important thing. And my well-being didn’t matter.”

She was barely sleeping. Even when she could get a release from what felt like breastfeeding purgatory, she couldn’t relax. As she got more and more exhausted, she started to get confused.

When she mentioned suicide her husband hospitalized her.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Where does a woman get the idea she must be a perfect mother? From the same place that some women get the idea that they must be a perfect wife and deserve to be beaten if they are not: she is socialized to it.[/pullquote]

Lisa doesn’t remember any doctors or nurses telling her why she was there or what was going on. But she does remember, about a week into her hospitalization, her husband bringing a printout from online about postpartum psychosis.

The article said elevated hormones from childbirth — plus sleep deprivation — can trigger confusion and paranoia. Lisa didn’t believe it — she thought her husband was tricking her and had spent hours using Photoshop to piece together a fake article.

Suicide claims many women in the year after a baby’s birth:

In the U.S., mental health problems are one of main contributors to maternal mortality, according to a 2018 report from a Centers for Disease Control and Prevention initiative called Building U.S. Capacity to Review and Prevent Maternal Deaths. On the report’s list of causes of death among new moms, mental health problems (which include drug overdoses) rank seventh — nearly tied with the complications of high blood pressure. For white women, mental health problems are the fourth leading cause of death.

Where did Lisa get the idea that her baby needed perfection?

It certainly wasn’t from the baby. As attachment theorist D.W. Winnicott first articulated, a baby needs only a ‘good enough’ mother by which he meant “the ordinary good mother … the devoted mother.”

As a Wikipedia article notes:

…[T]he idea of the good enough [mother] was designed on the one hand to defend the ordinary mother … against what Winnicott saw as the growing threat of intrusion into the family from professional expertise; and on the other to offset the dangers of idealisation …

But we didn’t need an attachment theorist to explain this reality. We are well aware that children can and do bond desperately to parents who abuse them.

I doubt it was from her own experience. Most people love their own mothers dearly despite recognizing (and complaining about) the fact that she is not perfect.

So where did she get the idea that she needed to be a perfect mother? From the same place that some women get the idea that they need to be a perfect wife and merit punishment from their husbands if they are not: she was socialized to it.

For most of human history women have been socialized to the idea that they must be perfect wives; meek, subservient, devoted to meeting any and every need a husband could dream up, no matter how ugly or unreasonable. Women were taught that when they “failed,” they deserved to be punished. Until very recently nearly every culture considered a wife’s body the property of her husband and he had the legal right to beat her, rape her or lock her away forever. Many cultures still do.

Even within our own culture, where we deem wife beating a crime, many women are abused and believe they deserve to be abused if they fail to meet their husbands’ expectations. “It was my fault!” is often the first thing a battered woman will say to the medical provider who discovers her injuries.

Why do women stay with abusive partners? There are a host of reasons but nearly always one of them is that the woman believes she owes her partner perfection and he is entitled to discipline her if she falls short.

Our culture, touting “attachment mothering,” socializes women to believe they owe their babies perfection. And mothers do believe it, eagerly disciplining other women — family, friends, acquaintances on social media — if they “fall short.”

Mothers (and “experts”) verbally abuse women who don’t or won’t comply. Telling a mother she must breastfeed or her baby will not bond to her is as abusive as telling a wife she must defer to her husband in every way or he will not love her. Both are ugly lies that serve no other purpose than to force women’s acquiescence.

Sadly, the journalists at NPR are every bit as socialized to such misogynistic beliefs.

Although they correctly identify the pressure to breastfeed as a trigger for postpartum psychosis, their “solution” is bizarre in the extreme.

The writer of the NPR piece approvingly describes a psychiatric facility designed for postpartum treatment:

Every room has a hospital-grade breast pump, Kimmel says, and there’s a lactation consultant who helps women with breastfeeding. The unit has a designated refrigerator for moms to store pumped milk.

What message does that send? It’s the equivalent of treating a woman who was beaten for burning her husband’s dinner by providing her with a kitchen and a cooking instructor.

It reinforces the same misguided, misogynist beliefs that brought her to this deadly impasse in the first place.

Fortunately, Lisa understood the opposite.

She had a second child but did not suffer a recurrence:

The psychosis did not come back after Vivian’s birth, in part because of all the precautions Lisa took. She made sure she got enough sleep. She gave herself permission to give up breastfeeding if it became too much.

“We’ve got so many messages of just self-sacrifice,” Lisa says. ” ‘Do anything for your kids.’ ‘Drop everything. That’s what it means to be a good mom.’ And for me, that’s not what made me a good mom. That’s what made me fall apart.

Words that other mothers struggling to meet unreasonable goals ought to take to heart. Because babies don’t require perfection from mothers; only other adults do.

I’ve heard from quite a few women that they initially found my website when they were googling “am I a bad mother for not breastfeeding?” or something similar. They write with gratitude that I reassured them that breastfeeding has nothing to do with it, that the benefits of breastfeeding have been exaggerated, and that their pain, suffering and mental health are worthy of consideration, too. As a result, they realize that it is okay to supplement their breastfed babies with formula, or give up breastfeeding altogether.

So today I want to make it official: you have my permission to stop breastfeeding!

You have my permission to stop breastfeeding (or supplement) if your baby seems frantic with hunger even after nursing repeatedly for long periods of time. His comfort is more important than what any lactation consultant has to say.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There is nothing in breastmilk that your baby needs more than your continued mental health.[/pullquote]

You have my permission to stop breastfeeding (or supplement) if your baby is not growing well, or worse, continues to lose weight after the first few days. The health of her brain is more important than your Facebook friends’ satisfaction that you are mirroring their own choices back to them.

You have my permission to stop breastfeeding (or supplement) if breastfeeding has become excruciating because of cracked, bleeding nipples, infections or no particular reason that you can identify. You are part of the much vaunted mother-baby dyad and your comfort matters, too.

You have my permission stop breastfeeding (or supplement) if you’ve been told you must subject your baby to the pain of tongue tie surgery if you want to breastfeed successfully and you can’t bear to do it.

You have my permission to stop breastfeeding (or supplement) if waking multiple times each night to nurse has left you incapacitated by exhaustion. Sleep deprivation is a risk factor for postpartum depression and you should to do everything you can to avoid that.

You have my permission to stop breastfeeding (or supplement) if you think you may be suffering from postpartum depression or postpartum anxiety. There is nothing in breastmilk that your baby needs more than your continued mental health … absolutely, positively NOTHING.

You have my permission to stop breastfeeding (or supplement) if you feel that breastfeeding is blighting your relationship with your infant. If you are beginning to resent your baby for being the source of your pain or if you simply can’t enjoy your baby because breastfeeding worries and attempts are occupying every spare moment, you can cut back or end breastfeeding altogether.

You have my permission to stop breastfeeding (or supplement) because in industrialized countries the benefits of breastfeeding term babies are so trivial as to be undetectable in the population. I would never give permission for anything that might harm your baby like refusing vaccines, but I know it makes no difference whether your baby gets breastmilk or formula.

You have my permission to stop breastfeeding (or supplement) because the risks of breastfeeding with insufficient breastmilk are not trivial: hypernatremic dehydration, hypoglycemia, kernicterus (severe jaundice), brain injuries and deaths. Indeed, exclusive breastfeeding at hospital discharge is probably the greatest risk factor for readmission.

You have my permission to stop breastfeeding (or supplement) because while breastfeeding may reduce the incidence of SIDS, pacifier use reduces it even more.

You have my permission to stop breastfeeding (or supplement) because NONE of the claims about breastfeeding and the microbiome have been substantiated.

You have my permission to stop breastfeeding (or supplement) because anger at formula manufacturers has led major professional societies to say and do nearly anything to discourage formula feeding even though it is an excellent option.

You have my permission to stop breastfeeding (or supplement) because the truth is that breastfeeding is a class signifier, not a health choice. Almost all the purported benefits of breastfeeding are actually benefits of the higher education level and socio-economic class of those who breastfeed, not breastfeeding itself. That’s why intending to breastfeed provides the same benefits as actually breastfeeding.

You have my permission to use or supplement with formula because buying someone else’s breastmilk is a waste of money better spent on saving for your child’s college education. It has NEVER been shown that donor breastmilk has any benefits for term babies.

You have my permission to never start breastfeeding in the first place. It’s your baby and your breasts. It should be your decision and no one else’s.

Who am I that my permission ought to matter? A medical professional recently complained that people only listen to me because of my Harvard education and training. If that’s the case, I won’t hesitate to take advantage of it. I am a Harvard educated, Harvard trained obstetrician-gynecologist who happily and successfully breastfed my own four children. That’s how I know it doesn’t make me a better mother than someone who formula feeds.

Of course you don’t need my permission at all. You could give yourself permission, but I recognize that some mothers, mired in the exhaustion of new motherhood and buffetted by the dire warnings of everyone from lactation consultants to Facebook friends, wouldn’t dare give themselves permission to ignore middle and upper middle class mothering norms. If you won’t give yourself permission, I hereby give you permission.

Just the fact that you’ve been consumed with worry about “am I a good mother?” means you already are!

We can thank the Editors at Scientific American for illustrating the famous H.L Mencken quote:

…[T]here is always a well-known solution to every human problem — neat, plausible, and wrong.

The U.S. Needs More Midwives for Better Maternity Care is a truly execrable piece lacking common sense, scientific support and historical accuracy. It’s neat, plausible and dead wrong.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]If mortality and C-section rates ROSE as the proportion of midwife attended births rose, how will increasing the number midwives make them fall? [/pullquote]

The ignorance is on display with the very first sentence:

Despite the astronomical sums that the U.S. spends on maternity care, mortality rates for women and infants are significantly higher in America than in other wealthy countries.

The fact is regardless of what ANY country pays on maternity care, mortality rates for black women and infant are significantly higher than other ethnic groups. The difference in mortality rates of industrialized countries largely reflects the proportion of black women in the population. “Whiter” countries have lower mortality rates.

For example, the US maternal mortality rate is 3-4X higher for black women than white women. In the UK, the difference is actually larger; black maternal mortality rate is 4-5X higher that of white women. So why does the UK have a lower maternal mortality rate than the US? Because black women represent 12% of the US population and less than 4% of the UK population.

…[T]he rate of cesarean sections is exceedingly high at 32 percent—the World Health Organization considers the ideal rate to be around 10 percent—and 13 percent of women report feeling pressured by their providers to have the procedure.

The World Health Organization FABRICATED their “ideal” C-section rate and as they themeselves have publicly acknowledged, there is no evidence and there has never been any evidence to support it. The best existing research on the topic shows that a MINIMUM C-section rate of 19% is necessary for low maternal and neonatal mortality and that rates above 40% are also compatible with excellent outcomes.

Having utterly mischaracterized the problem, the Editors offer their “solution:

Widespread adoption of midwife-directed care could alleviate all these problems. In many other developed countries, such as the U.K., France and Australia, midwifery is at least as common as care by obstetricians.

There is precisely ZERO evidence to support that claim. What are the C-section rates in these countries? It’s 33% in Australia, 26.2% in the UK and 20.8%. That’s hardly a ringing endorsement for the role of midwives in lowering the C-section rate.

What about maternal mortality? Women in the US die for LACK of access to high tech maternity care, the very care that midwives don’t provide.

A recent paper in New England Journal of Medicine What We Can Do about Maternal Mortality — And How to Do It Quickly offers four separate recommendations for reducing maternal mortality and all of them involve MORE high tech care, not less.

And if that weren’t enough to convince you that the Editors at Scientific American have no idea what they are talking about, consider this: the US C-section rate and maternal mortality rates have risen steadily as the proportion of midwife attended deliveries increased. How will increasing the number of midwives further lower these rates in the future when they couldn’t do so in the past?

In the U.S., certified midwives and nurse-midwives must hold a graduate degree from an institution accredited by the American College of Nurse-Midwives, and certified professional midwives must undergo at least two years of intensive training. This is designed to make midwives experts in normal physiological pregnancy and birth.

But whereas certified nurse midwives get similar education and training to European, Australian and Canadian midwives and meet the ICM [International Confederation of Midwives] international standards, “certified professional midwives” do not. Indeed, CPMs aren’t really midwives; they are lay people who are not allowed to practice in any other country in the industrialized world.

Most practicing CPMs have no education beyond a correspondence course and an apprenticeship with another substandard CPM. To understand just how poorly educated and trained these women are: the requirements for the CPM were “strengthened” in 2012 to mandate a high school degree. Almost all CPMs work outside hospitals at home or in unaccredited birth centers. Their neonatal mortality rates are 3-9X higher than those of nurse midwives. The Editors at Scientific American appear to have no understanding of this.

Nor do they understand that a midwifery who is an “expert in normal birth” is about as useful as meteorologist who is an expert in sunny whether. When birth is uncomplicated, you don’t need an any attendant, let alone an expert. You only need an expert when complications occur, the very situation for which CPMs lack education and training.

There’s much more wrong with the piece, including its revisionist history of the decline of midwifery care, but it’s enough to know that its central claims are flat out false. There is NO EVIDENCE that midwifery care decreases the C-section rate and NO EVIDENCE that midwives decrease the maternal mortality rate. Moreover, for the past decade the UK, where midwives are gatekeepers of maternity care has been rocked by a growing series of scandals involving the preventable deaths of dozens, perhaps hundreds of babies and mothers. Why did these babies and mothers die and why did hundreds more sustain severe injuries? In nearly every case it was because midwives refused to call for the doctors who could have saved them for fear of losing control over the patients.

Highly educated, highly trained nurse midwives are an asset in any US maternity care setting. I’ve worked with many and have high praise for the care they can provide BUT there’s precisely ZERO evidence that increasing the proportion of midwife attended births has any impact on either C-section rates or mortality rates. The Editors of Scientific American should be embarrassed that they ignored the scientific evidence — indeed appear to be utterly unaware of its existence — and printed midwifery marketing propaganda instead.

Yesterday I wrote about Meg Nagle, the Milk Meg, and her strenuous efforts to normalize infant starvation and maternal exhaustion. She’s hardly alone; nearly all lactation professionals have been desperately working to normalize infant suffering. It’s integral to the ongoing effort to promote breastfeeding regardless of the increasing rate of neonatal dehydration, starvation, brain injuries, falls from mothers’ hospital beds and smothering deaths within them. Sadly, their efforts are bearing fruit for them and suffering for babies. Exclusive breastfeeding on discharge has become the single biggest risk factor for hospital readmission.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Who benefits from normalizing maternal suffering? Natural childbirth advocates, lactivists and misogynists.[/pullquote]

When it comes to normalizing maternal suffering, Meg and her lactation colleagues have lots of company. What are natural childbirth advocates and midwives seeking to promote “normal birth” doing if not normalizing maternal agony? And what are advocates of attachment parenting doing if not normalizing women restricting themselves to “women’s work”?

No doubt you’ve heard their admonitions:

Labor pain is good pain!

Babies do not need to learn how to fall asleep on their own. Just breastfeed!

If you’re too tired to care for your baby in the hospital, what are you going to do when you get home?

You should stop taking your antidepressants or the medications that control your ulcerative colitis or your epilepsy so you can breastfeed!

So how can you stay comfortable, rested and healthy when there are so many “professionals” who think you should be suffering instead?

Just remember: your baby doesn’t need you to suffer.

There is NO benefit to your baby from enduring labor pain.

Sure the baby must exit your body somehow and a significant amount of pain is unavoidable either from labor pain or C-section pain but there’s no harm to your baby from minimizing either.

There is NO benefit to your baby from “normal birth.”

Yes, I realize that this is the bread and butter of midwives, doulas and childbirth educators, but their economic wellbeing pales in significance compared to the health of your baby and yourself.

C-sections are safer for babies. The liberal use of interventions is preventive medicine. And waiting for your due date to come and go actually increases the risk of complications for both you and your baby.

There is virtually NO benefit to your term baby from breastfeeding.

Indeed, the benefits are so small that they are literally undetectable in large populations. Breastfeeding is a good thing but it’s only one of two excellent ways to nourish a baby.

Therefore, there is no benefit to exclusive breastfeeding.

It’s great if it works for you and your baby, but it’s equally fine if it doesn’t. There’s no need to torture yourself pumping between feedings if you have insufficient breastmilk. There’s no need to get up in the middle of the night to breastfeed if someone else can give your baby a bottle of formula.

There is no benefit for you in waking up multiple times each night.

Yes, your baby must be fed when he or she is hungry and must be comforted when ill or in distress, but that doesn’t mean that you always have to be the one to do it. Your partner can help, your parents/in-laws can help, nannies and au pairs can help.

There is no benefit to having your baby strapped to you, sleeping in your own bed, or always within inches of wherever you are.

Some women find those things enjoyable and should of course do them (with the exception of bed-sharing, which increases the risk of SIDS). But other women need time and space to themselves, need to socialize with others without the baby, or need to work. There is nothing wrong with enjoying them.

Don’t get me wrong, you WILL suffer even if you take heed of the above precepts. You will suffer some pain and exhaustion because it is impossible to completely avoid either. But most of your suffering will have nothing to do with childbirth, infant feeding or attachment parenting.

You will suffer when your child is ill.

You will suffer when your child is in pain, physical or psychological.

You will suffer if your child gets injured.

You will suffer if your child has a disability, a learning issue, difficulty making friends at school.

You will suffer with worry over and over and over again. The only thing that will change as the years go by is the specifics of what you are worry about this time.

But none of that benefits your child, either.

If maternal suffering doesn’t benefit children, who does it benefit?

It benefits those who make money by convincing women to endure the suffering, and sell books, courses and service to support them through the suffering: midwives, doulas and lactation consultants in particular.

And it benefits misogynists who believe that women exist to suffer and sacrifice for others. As 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…

Sunna Simmonardottir notes:

…[M]others are instructed to direct all their physical and emotional capacities at their children and … the maternal body and mind is subject to disciplinary practises…

Susan Franzblau has written:

The idea that women are evolutionarily prepared to mother … is consistent with a long historical tradition of using essentialist discourse to predetermine and control women’s reproductive tasks and children’s rearing needs… If the treatment of women differs from the treatment of men, such treatment could be justified in terms of its biological and evolutionary purposes…

In other words, it benefits many people but not women themselves.

Natural childbirth advocates — midwives, doulas, purveyors of books and courses — should stop normalizing maternal suffering.

Lactation professionals and lactivists should stop normalizing maternal suffering.

Misogynists should stop normalizing maternal suffering.

I have no hope of convincing any of these people to do so. They have too much at stake financially or psychologically to give up what has been an enriching and enjoyable practice. But I am working diligently to convince women that they don’t have to listen to those who normalize their suffering.

Your baby doesn’t need you to suffer. Don’t let anyone else tell you otherwise.

I have an advantage over most of you, including most lactation professionals. I’m old enough to remember when neither infant starvation nor maternal exhaustion were touted as “normal.”

I did my medical training — and I breastfed my four children — before promoting breastfeeding was deformed by lactation professionals into dystopian efforts to force women to breastfeed regardless of their wishes and regardless of the consequences.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]As the harms of aggressive breastfeeding promotion have become more common, lactation professionals have devoted themselves to normalizing those harms.[/pullquote]

What do I mean by “dystopian”? A dystopian society is one in which oppressive social control is required to support the illusion of perfection. Sadly, contemporary lactivists imagine that oppressive social controls are required to support the illusion that breastfeeding is perfect for every mother and every baby.

The Baby Friendly Hospital Initiative (a truly dystopian name for an initiative that often harms both babies and mothers) is the paradigmatic example of contemporary lactivism. It involves mandatory education efforts, muzzling of providers, locking up infant formula and forcing women to sign consent forms detailing its “dangers.” Even worse, because lactivists cannot admit that breastfeeding is anything but perfect, it has led to a rise in serious iatrogenic complications including infant dehydration, starvation, brain injury and even death.

The BFHI is an institutional effort but the regime, like any dystopian regime, has many enforcers in the form of lactation professionals who make their money by promoting breastfeeding. Obviously, there is nothing wrong with the concept of lactation professionals. It is perfectly reasonable for some women to make money offering education and support that many women want.

The problem occurs when lactation professionals forget they exist to support women and babies and imagine they exist to support a regime of universal breastfeeding. Sadly, as the harms of aggressive breastfeeding promotion have become more common, lactation professionals have devoted themselves to normalizing those harms.

How do lactivists normalize infant starvation? They:

• Lie about stomach size
• Assert cluster feeding is normal
• Insist poor weight gain is acceptable
• Claim “one bottle” can destroy supply
• Tell women to ignore pediatricians who are concerned

A hungry baby is one who cannot settle and wakes up repeatedly through the night to feed. Thus lactation professionals have been forced to normalize maternal exhaustion.

Meg Nagle has become a world leader in normalizing both infant starvation and maternal exhaustion. That effort is encapsulated in her motto, “Just Keep Boobin’.” It is meant to encourage women to keep breastfeeding no matter what happens, to never question whether a baby might be starving, and to always ignore her own needs in favor of breastfeeding.

Meg has a nearly endless supply of memes and I encourage you to look them over. Nearly all reflect her desperate effort to normalize infant starvation, maternal exhaustion or both.

Normalizing infant starvation

The frequency in which your baby feeds is not an indication of how much milk they are getting.

And:

A baby who is unsettled after a breastfeed or feeding constantly will not autonomatically need formula…

And:

Yes I’m eating but … You do know that I’ll still want to boob every five minutes right??

And:

A schedule of breastfeeds every three hours is often not looked at fondly by your baby. Why? Because babies breastfeeding for so many reasons than just hunger…

And:

The amount you pump is not an indication of how much you make or how much your baby receives.

And:

Don’t worry about your baby’s … feeding cues. The second they make a peep … just breastfeed them.

Normalizing maternal exhaustion

Feeding your baby back to sleep. Not a mistake, the biological norm! Most babies will need a mid-nap breastfeed and frequent feeds during the night. For months or years.

And:

I finally discovered the three easy steps to breastfeeding: Cancel everything else in your life. Lay down topless on the couch with your child. Stay there for 2 years.

And:

Babies do not need to learn how to fall asleep on their own. They need to fall asleep with … some boobie.

And:

Your baby is not “using you” as a pacifier. A pacifier takes the place of what normally happens at the breast.

And:

Mothering THROUGH breastfeeding at night is the biological norm.

And:

Instead of asking her, “Is your baby sleeping through the night?” try, “is your baby breastfeeding well through the night.

And:

Is it normal for my toddler to breastfeed all the time day and night? Yes. The end.

It goes on and on and on and on. And just in case you were unclear that Meg is trying to normalize infant starvation and maternal exhaustion, she helpfully includes the word “normal” and even the hashtag #normalizenightwaking.

In the dystopian novel 1984, George Orwell introduced the idea that vocabulary has the power to control thought. In 1984, the government, in an effort to control citizens and force them into submission, perverts the meaning of common words and phrases to promote approved views and stamp out unapproved views. The classic example of this effort is the following quote:

War is peace.
Freedom is slavery.
Ignorance is strength.

In the current lactivist dystopia:

Frequent, frantic efforts to take in enough nutrients is “bonding.”
Sleep constantly broken by hunger is “soothing.”

Orwell also said:

Orthodoxy means not thinking – not needing to think. Orthodoxy is unconsciousness.

Meg and other lactation professionals don’t need to think; they’ve been told what to think in order to maintain the oppressive social controls required to support the illusion that breastfeeding is perfect for every mother and every baby. Lactation professionals reflexively and unconsciously normalize the abnormal … and that includes normalizing infant starvation and maternal exhaustion

Natural childbirth advocates and lactivists like to claim that I hate vaginal births and breastfeeding. Never mind that I had four vaginal births and breastfed all four of my children. It seems beyond their powers of reasoning to imagine that someone could choose something for herself without insisting that everyone else ought to choose it too. They cannot fathom that a choice could be “best for me,” but that doesn’t make it “best.”

The claims made about natural childbirth and breastfeeding are not supported by the scientific evidence; benefits are exaggerated by professionals who earn their living from promoting them; and they are fundamentally misogynistic, inevitably requiring as they do re-immuring women into the home. So why has it become conventional wisdom that natural childbirth and breastfeeding are best? Because they denote privilege.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The ugly truth is that breastfeeding has become “best” because only the “best” people can afford to do it.[/pullquote]

Privilege is a sine qua non of natural mothering and not merely the economic privilege that allows natural mothers to purchase expensive specialty products. One must have access to a highly technological lifestyle in order to give meaning to rejecting it.

I’m not the only one who has realized this. So has Elizabeth Carrid-Halkett, although in her book The Sum of Small Things: A Theory of the Aspirational Class she refers to it a bit differently: natural childbirth and breastfeeding are class signifiers.

Who are the aspirational class? It’s not merely a function of wealth.

…[T]hey reveal their class position through cultural signifiers that convey their acquisition of knowledge and value system—dinner party conversation around opinion pieces, bumper stickers that express political views and support for Greenpeace, and showing up at farmer’s markets. These behaviors and signifiers imply aspirational class values and also suggest the knowledge acquired to form them.

Thus:

Social norms and goods of the aspirational class reflect an implicit knowledge and procurement of knowledge that informs their consumption practices. Aspirational class leisure, whether reading the Economist, listening to NPR, or taking a yoga class, is imbued with knowledge and productivity in the same spirit as work.

And motherhood is a particular focus of the aspirational class, specifically because of the conspicuous leisure required to “perform” it. That’s why breastfeeding, for example, is so closely associated with maternal education and socio-economic class.

Mothering, writ large, has become a new channel for engaging in what Veblen termed conspicuous leisure. Breast-feeding and birthing practices are the most obvious examples of this, as playing sports or studying Greek were in Veblen’s time. Unlike a Louis Vuitton bag or a luxury car, these signifiers are not explicitly expensive but they do require significant investments of time, an even more precious commodity in modern society…

Wait! Aren’t these practices free for everyone?

While many aspects of motherhood seem costless — birthing choices, co-sleeping, carrying your baby, breastfeeding — women can only engage in these activities if they have the luxury of time and leisure and membership into cultural and social groups that encourage this form of motherhood. Certain maternal choices demonstrate the possession of both time and cultural capital that is truly impossible for many women to attain.

The author references French scholar Roland Barthes and his book Mythologies:

…Through the dominant values upheld by society we create “myths” around particular practices and consumer goods, which become “signifiers” of particular messages or dominant belief systems.

In our society, we have created a myth around motherhood, the myth of “attachment” mothering, which has become a critical signifier of membership in the aspirational class. Breastfeeding — because it can be “performed” before others — has become perhaps the most important signifier of all.

It is mainly prevalent in particular cultural and class groups — women with higher education levels who learn about the benefits of breast-feeding and women of higher income groups who can afford the insurance to deliver in baby-friendly hospitals with round-the-clock nurses and lactation consultants providing breastfeeding classes, expensive and efficient breast pumps, and help throughout the mother’s entire stay. One of the other significant predictors of breast-feeding success is duration of maternity leave: … In the United States, good maternity leave is a rare thing for all women, but those who receive it are primarily women in high-level professional jobs. …

What about everyone else?

…[A]s the sociologist Cynthia Colen summed it up, “In the United States, where only 12 percent of female workers and 5 percent of female low-wage workers have access to paid leave, most women are required to forgo income in order to breast-feed. This may be a less-than-ideal situation for middle-class women but an impossible situation for poor women who already are having trouble making ends meet.

That’s yet another reason why aggressive efforts to promote breastfeeding are cruel in the extreme:

Given that breast-feeding requires a whole host of resources and time that poor mothers may not have, low-income mothers are limited in their ability to breast-feed, even if it is not physiologically based. Breast-feeding might be the ideal choice, but these women often do not have the chance to do so.

The ugly truth is that breastfeeding has become “best” because only the “best” people can afford to do it.

Breastfeeding is the designer handbag of mothering. No woman should feel guilty about not owning a designer handbag and no mother should feel guilty about not breastfeeding. Just as a regular handbag is an excellent way to carry your wallet and car keys, formula feeding is an excellent way to nourish an infant. Contrary to claims of the aspirational class, breastfeeding is merely a class signifier, NOT a sign of maternal devotion.

This is public service announcement on how to protect yourself from misogynistic mothering bullshit (MMB). Sadly, too much of what passes for parenting advice in 2019 is MMB.

Consider the latest example. Why it’s actually a good thing if your baby doesn’t sleep through the night is misogynistic mothering bullshit of the highest order, involving as it does fabrication of benefits for babies to justify suffering of mothers.

Professor Peter Fleming who specialises in developmental psychology at the University of Bristol told Buzzfeed that babies are not designed to sleep for long periods, and it’s normal for them to wake.

“It’s not good for them, and there is absolutely no evidence whatsoever that there is any benefit to anybody from having a child that sleeps longer and consistently.

That is classic MMB, but like most misogynistic mothering lies it’s bullshit with a purpose. The purpose is to shame mothers who dare to consider their own needs.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It’s bullshit with a purpose: to shame mothers who dare to consider their own needs.[/pullquote]

How can you recognize MMB like this. I hereby offer Tuteur’s Criteria to help you protect yourself.

1. Was it promulgated by an old white man?

Misogynistic mothering bullshit is almost always propagated by old white men. This is neither a necessary nor a sufficient criterion of MMB, but it is startlingly common. Don’t misunderstand me; old white men aren’t all bad and can occasionally offer scientifically valid insights about mothering. But Dr. Peter Fleming follows the path from Grantly Dick-Read in the 1930’s to William Sears in the 1990’s, a long tradition of old white men offering bullshit advice meant to keep women immured in the home.

2. Does it invokes the naturalistic fallacy and/or the Panglossian paradigm?

The naturalistic fallacy is the is/ought fallacy; if something is a certain way in nature, that’s the best way for it to be. The Panglossian paradigm is the belief that every human organ/function/behavior is a product of intense evolutionary selection, as opposed to the reality that evolution does not produce perfection, that traits beneficial in one evolutionary environment may not be beneficial in another and that there are genetic limits to evolution.

Invoking the “design” of babies, as Dr. Fleming does above, represents both the naturalistic fallacy and the Panglossian paradigm. Even if babies were “designed” to wake during the night that doesn’t mean it’s good for babies or good for mothers.

3. Does it rely on the noble savage trope, homogenizing tens of thousands of years of human existence and thousands of cultures into one set of “ancestors” who had one set of parenting practices?

There is no single way that human mothers have raised children across time and cultures. Moreover, existing indigenous people are not necessarily representative of ancient human cultures any more than existing animals are representative of animals that existed in the past.

There’s no clearer indicator of the noble savage trope that the racist invocation of black African mothers. Dr. Fleming once again comes through:

I’ve done quite a lot of work in Africa and in various other places and babies are carried around with their mother all the time. They’re asleep when they need to sleep and they’re awake when they need to be awake, but they’re constantly with their mother and that facilitates breastfeeding.

4. Does it fabricate benefits for babies that are not supported by or are directly contradicted by scientific evidence?

Dr. Fleming does not appear to be constrained by scientific evidence at all. He surrenders himself to fantasy. He claims that there are no benefits to babies from sleeping well when existing scientific evidence is either agnostic on that point or associates improved sleep with improved infant wellbeing. His claim that mothers don’t benefit from long stretches of uninterrupted sleep is MMB par excellence. There is a reason why sleep deprivation is considered torture … because it IS torture. Poor quality sleep is associated with postpartum depression and other harms to women.

Professor Fleming explains that there’s a very clever reason why babies wake through the night.

“Biologically that’s a big advantage because they will have more attention from their two primary caregivers at that time of day than at any other, because there are fewer distractions.

Is this guy on drugs? Does he imagine that parenting across time and culture involved fathers caring for their babies? What evidence does he have that by waking up during the night improved the father-infant relationship or the overall wellbeing of babies? None, of course. His prejudice in favor of traditional two parent nuclear families is showing here.

Professor Fleming makes the connection between very high levels of developmental and intellectual achievement and not sleeping throughout the night.

It’s hard to find a clearer example of MMB than that nonsensical claim.

5. Does it imply that human evolution stopped 20,000 years ago and that our current culture is incompatible with our evolution?

Professor Fleming says biological sleep patterns can’t suddenly be changed just because the modern world operates to a different schedule than humans did thousands of years ago.

Fleming said: “One needs to remember that society changes faster than biology. A biological pattern that’s taken half a million years to develop can’t just be suddenly ignored and turned around…

Really? Then how did humans develop lactose tolerance very quickly after the introduction of animal milk into the human diet? Because the mutation that allowed humans to benefit from the ability to digest animal milk was present in the human population and selection pressure quickly favored it and allowed for rapid spread.

6. Does it promote the modern nuclear family with mother relegated to the home as “best,” ignoring the traditional tribal band where everyone worked to improve the survival of the group.

Though nearly all MMB claims purport to be about restoring traditional mothering practices, the real goal is making recent mothering practices (those developed within the past 1-2 centuries) normative. It is very similar in that sense to efforts by homophobic activists to restore “traditional marriage” imagining that a man and a woman marrying for love is traditional when the truth is that “traditional marriage” was about families trading their sons and daughters for protective alliances and material gain.

To qualify as MMB, a claim doesn’t need to meet all of Tuteur’s Criteria for misogynistic mothering bullshit but Dr. Fleming’s claims do meet them all. What’s really going on here?

Dr. Fleming seeks to promote breastfeeding and the deadly practice of bedsharing.

[Babies are] asleep when they need to sleep and they’re awake when they need to be awake, but they’re constantly with their mother and that facilitates breastfeeding…

The idea that sharing a sleep surface with your baby is in anyway wrong, abnormal or peculiar is just nonsense,” he says. “Most people in the world would see that view as bizarre – 90pc of the human infants on this planet sleep that way every night and over the half a million years of human evolution that’s been the norm.

Over the half million years of human evolution, massive child mortality has also been the norm. Just because something is natural doesn’t make it safe, healthy or “best.”

Why do hospitals let bad things happen to good people?

The reason can often be found in efforts to meet government quality metrics. As a recent editorial in JAMA, Unintended Harm Associated With the Hospital Readmissions Reduction Program, explains:

… The HRRP [Hospital Readmissions Reduction Program] imposed financial penalties on hospitals based on rates of 30-day risk-standardized hospital readmission for heart failure, acute myocardial infarction, and pneumonia, with up to 3% of a hospital’s total Medicare revenue from admissions for any condition (target or nontarget) at risk. In fiscal year 2018, 80% of the hospitals subject to the HRRP have been penalized, amounting to $564 million in reduced payments by Medicare.

The government wanted to improve the quality of care of those who had to be readmitted ostensibly because they hadn’t been adequately treated during the initial hospitalization.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Many babies are starving and some are starving to death.[/pullquote]

And it worked! Hospital readmissions were reduced and payments to hospitals were also reduced.

There was just one teeny, tiny problem:

Using an interrupted time-series analysis approach, an analysis of clinical data from Get With The Guidelines – Heart Failure linked to Medicare data demonstrated an increase in 30-day and 1-year mortality associated with the implementation of the HRRP…

The analysis also demonstrated that the overall increase in mortality associated with the HRRP was mainly driven by patients who were not readmitted to the hospital, but who died within 30 days of discharge. This finding, in particular, enhances the likelihood of a causal relationship between the HRRP financially incentivized restricting of inpatient readmissions and the harm observed.

The “successful” program killed patients by restricting access to the medical care they needed to survive.

How did things go so very wrong? It’s all about the assumptions:

Assumption 1: Cardiac patients readmitted within 30 days would not have been readmitted if they had been better treated in the initial admission. In other words, readmission was a sign of low quality.
Assumption 2: Refusing to pay for readmissions would incentivize hospitals and providers to improve quality of the initial admission.
Assumption 3: Patient health would be improved while money was being saved.

All three assumptions turned out to be wrong and a modicum of understanding of both medical care and human nature would have made that it clear that the deadly results were practically inevitable.

1. Readmission rates are not a quality metric in this setting of frail, elderly people suffering chronic diseases. Readmission is a function of how sick the patients are not how good the treatment is.
2. Since readmission rates are not a quality metric, no amount of incentivization can improve the health of discharged patients.
3. By penalizing hospitals for relapses they could not prevent, they incentivized hospitals to refuse to readmit the very patients that needed readmission most. Those patients died.

This is what happens when government (or any institution) chooses to make a metric that has little to do with quality of care into a quality metric and penalizes hospitals and providers who can’t reach it.

The same thing has happened to breastfeeding support with the same deadly result, although in this case the patients who are harmed are newborn babies and their mothers.

Contemporary breastfeeding promotions efforts, in particularly the Baby Friendly Hospital Iniative (BFHI), have made breastfeeding rates into a quality metric by employing the same faulty assumptions that let to the deaths of heart patients.

Assumption 1: All women can and would breastfeed exclusively if they received enough education and support.
Assumption 2: Incentivizing hospitals to improve breastfeeding rates will lead to more babies being breastfed successfully.
Assumption 3: Infant health will be improved.

Aggressive breastfeeding promotion efforts have also “worked.” Exclusive breastfeeding rates on discharge have risen by more than 200%.

At the same time newborn hospital readmissions for breastfed babies are double that of bottle fed babies accounting for tens of thousands of hospital readmissions each year in the US alone. Indeed the single biggest risk factor for newborn hospital readmission is exclusive breastfeeding on discharge. Breastfeeding is a leading factor or the leading factor in an increase in neonatal hypernatremic dehydration, kernicterus (severe jaundice) and the permanent brain injuries and deaths that can result.

Many babies are starving and some are starving to death.

What went wrong? All three assumptions turned out to be wrong and a modicum of understanding of both medical care and human nature would have made that it clear that deadly results were practically inevitable.

1. Breastfeeding rates are NOT a quality metric; not all women can produce enough breastmilk to fully nourish a baby and not all women want to breastfeed.
2. Since not every mother can or wants to breastfeed, incentivizing hospitals to increase breastfeeding leads them to pressure, shame and punish mothers who wish to use formula.
3. Incentivizing hospitals to improve breastfeeding rates to 100% when approximately 15% of first time mothers cannot produce enough breastmilk in the early days to adequately nourish an infant leads hospitals to withhold formula from babies who desperately need it. Incentivizing hospitals to increase rates of skin-to-skin contact and rooming in leads to an increase in newborn deaths as infants smother in or fall from their mothers’ hospital beds.

These deadly results were nearly inevitable once government decided to make breastfeeding rates — which are not and never were a metric of quality — into a quality metric.

When government makes readmission rates a quality metric, hospitals respond by withholding readmission and patients die as a result. When government makes breastfeeding rates a quality metric, hospitals respond by withholding formula and babies die as a result.

The road to patient hell is paved with quality metrics. In the case of breastfeeding promotion, it’s pretty easy to save babies and mothers from hell: just stop pretending that breastfeeding rates have anything to do with either hospital quality or infant health.

Does this remind you of any providers you know?

Preventive medicine displays all 3 elements of arrogance. First, it is aggressively assertive, pursuing symptomless individuals and telling them what they must do to remain healthy. Occasionally invoking the force of law …, it prescribes and proscribes for both individual patients and the general citizenry of every age and stage. Second, preventive medicine is presumptuous, confident that the interventions it espouses will, on average, do more good than harm to those who accept and adhere to them. Finally, preventive medicine is overbearing, attacking those who question the value of its recommendations.

It reminds me of most of the prominent lactation professionals who have made it their mission to promote breastfeeding.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]As the evidence mounts it is becoming clear that breastfeeding term babies is a lifestyle choice, NOT a health choice.[/pullquote]

Professional lactivists are aggressively assertive because they are true believers. They not only pursue mothers of symptomless infants, they corral them in programs like the Baby Friendly Hospital Initiative, tell them what is “best” for their babies and then force them to do it.

They are indiscriminate in their recommendations. No nuance for them. As Dianne Weissinger, arguably the mother of contemporary breastfeeding advocacy, wrote:

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

They are so presumptuous as to defy belief. They don’t know you; they don’t know your baby, but they actually imagine that care more about your baby than you do.

And they are oh, so overbearing, viciously attacking anyone who dares to question the benefits of breastfeeding as shills, liars and losers.

But the quote is not about breastfeeding. It was written in 2002 by David Sackett, a physician, epidemiologist and one of the pioneers in the discipline of evidence based medicine (EBM). He was writing about the hormone replacement therapy debacle. Estrogen/progestin was recommended for nearly all healthy postmenopausal women to protect them against cardiovascular disease. All the major professional societies backed it and it was used as a metric to judge the performance of doctors within health organizations.

The Women’s Health Initiative randomized controlled trial … was stopped when it became clear that the participating women’s risk of cardiovascular disease went up, not down, on active therapy. This damage began to develop soon after randomization, and after a mean follow-up of 5.2 years the trial was stopped for harm. In human terms, the 8506 women treated with estrogen plus progestin had about 40 more coronary events, 40 more strokes, 80 more episodes of venous thromboembolism and 40 more invasive breast cancers than the 8102 women assigned to placebo. Given the frequency with which this treatment is prescribed to postmenopausal women worldwide, hundreds of thousands of healthy women have been harmed.

How could good people have done something so bad?

I place the blame directly on the medical “experts” who, to gain private profit (from their industry affiliations), to satisfy a narcissistic need for public acclaim or in a misguided attempt to do good, advocate “preventive” manoeuvres that have never been validated in rigorous randomized trials. Not only do they abuse their positions by advocating unproven “preventives,” they also stifle dissent. Others, who should know better than to promote “preventive” manoeuvres without clinical trials evidence, are simply wrong-headed. When a 1997 systematic review of 23 trials of postmenopausal hormone therapy concluded that this treatment substantially increased the risk of cardiovascular disease, the attack on its results included a public announcement from a prominent editorialist: “For one, I shall continue to tell my patients that hormone replacement therapy is likely to help prevent coronary disease.”

The purported benefits of HRT had been shown in observational trials and the experts believed. Never mind that not only could those benefits not be reproduced in larger studies, but they were debunked by larger studies. No matter. The purported benefits of breastfeeding have not been reproduced in larger studies and have never come to pass in large populations. No matter. Prominent lactation professionals (and many medical professionals) ignore those results and criticize anyone who tries to publicize the fact that the benefits don’t exist and the harms (neonatal dehydration, starvation, injury and death) are very real. When pressed, they typically retort ‘I shall continue to tell my patients that breastfeeding is best regardless.’

Over the past few days I have been involved in a discussion on Twitter that was precipitated by a meme I posted.

Imagine we learned that a product promoted as healthy for babies was responsible for 90% of cases of jaundice induced brain damage, a dramatic increase in brain injuries and deaths from dehydration and double the risk of newborn hospital readmission. Now imagine that we refused to do anything about it. That product is breastfeeding.

The response from some providers was basically ‘how dare you?’

One participant, a nutritionist/dietician from Colombia went so far as to write:

That point of view just makes no sense. It will never come to my mind the idea of recommending something different from breastfeeding, formula will never be my first advice to patients, just in some special cases…

It no longer matters to many lactivists what the data shows. They are so arrogant that the data is irrelevant and anyone who dares to disagree is maligned and shouted down.

The most astounding comment came from a woman representing herself as a physician. Pointing to my Harvard credentials she wrote:

Sigh….how much traction would you get if your bio said you were an ob/gyn from _____unknown to most University, college.

I was taken aback by this, but the more I think about it, the more pleased I am. I try to be a voice for women/babies whose suffering is routinely dismissed. Providers should stop ignoring them, but if the alternative is they can’t ignore me/my Harvard credentials, that will do.

So let me speak directly to mothers struggling to breastfeed:

As a Harvard educated, Harvard trained obstetrician who breastfed her own four children I can assure you that the benefits of breastfeeding term babies in industrialized countries are so trivial as to be undetectable.

IT DOESN’T MATTER WHETHER OR NOT YOU BREASTFEED. It’s a lifestyle choice, not a health choice.

The lactation professionals and medical professionals who tell you otherwise are no different from those who continued to aggressively promote hormone replacement therapy despite mounting evidence that it didn’t work and actually caused harmed. They are arrogant.

Please don’t let their arrogance harm your baby’s physical health or your mental health!

Shell shock was first described one hundred years ago:

During the early stages of World War I in 1914, soldiers from the British Expeditionary Force began to report medical symptoms after combat, including tinnitus, amnesia, headaches, dizziness, tremors, and hypersensitivity to noise. While these symptoms resembled those that would be expected after a physical wound to the brain, many of those reporting sick showed no signs of head wounds. By December 1914 as many as 10% of British officers and 4% of enlisted men were suffering from “nervous and mental shock”.

Today we would call it PTSD (post traumatic stress disorder). Back then many people called it cowardice:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactivists treat women struggling to breastfeed the same way the British Army treated men suffering from shell shock: with contempt.[/pullquote]

Some men suffering from shell shock were put on trial, and even executed, for military crimes including desertion and cowardice. While it was recognised that the stresses of war could cause men to break down, a lasting episode was likely to be seen as symptomatic of an underlying lack of character.For instance, in his testimony to the post-war Royal Commission examining shell shock, Lord Gort said that shell shock was a weakness and was not found in “good” units. The continued pressure to avoid medical recognition of shell shock meant that it was not, in itself, considered an admissible defence.

It’s appalling when you think about it. Men who were suffering quite severely were treated with contempt instead of compassion. Why? Two reason. First, the army needed men to fight the battles; offering compassion would limit the number of men they could press into service in their enterprise. Second, it was a powerful rebuttal to the story the army told itself about the glory of war.

Sadly, such behavior is still common. We see it today in contemporary breastfeeding advice.

Consider these responses by a lactivist in a Twitter conversation about women suffering as a results of pressure to breastfeed. She is responding to others in the thread and I’ve arranged them in chronological order from earlier to later tweets (not all responses are included).

Sabire’s contempt for women who don’t breastfeed, or worse question the glory and absolute necessity of breastfeeding, oozes from her words.

..you never much liked the idea of breastfeeding to start with and are more in your social and emotional ‘comfort zone’ with bottlefeeding. Impossible for some women to be honest about it:

You were always weak.

…Most people think that if they can’t ^see^ the benefits, then they’re not real.

How dare you question what we tell you!

…If women aren’t reading or accessing this information, if they spend 10x the amount of time researching what buggy to buy as to ‘what are the challenges of establishing breastfeeding and where can I get help?’ then whose fault is that?

It’s all your fault!

… in countries where breastfeeding is the social norm, you don’t get huge numbers of women who feel ‘broken’ – not by pathological breastfeeding (thrush, tongue tie etc) – by but by NORMAL and functional breastfeeding as you see here in the U.K.

If other people can do it, so can you.

We should be asking what it is about U.K. culture that so many new mums feel broken by a normal physiological function that most women in other countries manage without loads of emotional distress.

Perhaps it’s a defect in your upbringing.

It made a relevant point about normalising dysfunction, which people do all the time in relation to breastfeeding and is part of the reason so many women lose heart with it. I’m sorry you can’t see that.

Don’t expect any sympathy for your whining.

Instead of treating women who are sharing their struggles with compassion, Sabire cannot be bothered to hide her contempt. Women who have difficulty breastfeeding are ‘weak, lazy, defective, and incapable of doing what real women do routinely.’ They are malingerers who want to be coddled instead of doing their duty.

Which is precisely what they told shell shocked soldiers in an effort to get them to ‘snap out of it.’

Another lactivist in the conversation is equally contemptuous. Psychology professor Amy Brown recently wrote a piece entitled Here’s Why You Should Ignore Those Breastfeeding Horror Stories:

Try not to pay too much attention to breastfeeding horror stories. People like to share stories – it makes them feel better – without thinking about the consequences for you …

It boggles the mind that a psychology professor — a psychology professor!! — looks at women who are desperate to be seen and supported and responds by telling us to ignore them. Would she tell military personnel to “ignore” the PTSD of returning veterans, not pay “too much” attention to them and treat them as nothing more than a drag on morale?

Perhaps the most famous incident involving shell shock occurred during WWII when General George Patton became enraged when finding a man among the hospitalized troops who was not obviously injured. Told that it was his nerves:

He began yelling: “Your nerves, hell, you are just a goddamned coward. Shut up that goddamned crying. I won’t have these brave men who have been shot at seeing this yellow bastard sitting here crying.” Patton then reportedly slapped Bennett again, knocking his helmet liner off, and ordered the receiving officer …. not to admit him. Patton then threatened Bennett, “You’re going back to the front lines and you may get shot and killed, but you’re going to fight. If you don’t, I’ll stand you up against a wall and have a firing squad kill you on purpose. In fact, I ought to shoot you myself, you goddamned whimpering coward.”

It was an ugly incident and Patton was ultimately reproved for it and a similar reaction to another soldier. Eisenhower himself was involved and wrote to Patton:

I clearly understand that firm and drastic measures are at times necessary in order to secure the desired objectives. But this does not excuse brutality, abuse of the sick, nor exhibition of uncontrollable temper in front of subordinates…

Soldiers diagnosed with shell shock were not weak, lazy, defective or incapable of doing what others do “easily.” They deserved to be treated with compassion, not contempt. Women struggling with breastfeeding are not weak, lazy, defective or incapable of doing was others do easily. They deserved to be treated with compassion and lactivists should be deeply ashamed of themseleves and should apologize immediately and profusingly for treating them cavalierly and with contempt.

I’m not holding my breath, though. Just as army officers viewed the sufferers of shell shock as a powerful rebuttal to the story they told themselves about the glory of war, lactivists view women who struggle to breastfeed as a powerful rebuttal to the story they tell themselves about the perfection of breastfeeding. Compassion would lead to cognitive dissonance. It’s easier and more satisfying for lactivists to treat suffering women brutally and with contempt.