Every war requires uniforms so that you can tell ally from enemy. The mommy wars are no exception.

Amber teething necklaces for infants are part of the crunchy mommy “look” that allows self-described natural mothers to signal their allied status to other crunchy moms and to set them apart from the mainstream. Too bad that amber teething necklaces are deadly, but babies must make sacrifices to promote their mother’s brand.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Amber teething necklaces not only AREN’T useful for treating teething pain, they COULDN’T be useful since the active ingredient isn’t released from the beads.[/pullquote]

The FDA has received reports of death and serious injuries to infants and children, including strangulation and choking, caused by necklaces and bracelets often marketed for relieving teething pain… The risks of using teething jewelry include choking, strangulation, injury to the mouth, and infection…

Strangulation can happen if a necklace is wrapped too tightly around the child’s neck or if the necklace catches on an object such as a crib. The FDA received a report of an 18-month old child who was strangled to death by his amber teething necklace during a nap…

This is not rocket science, people! The same babies who should have grapes cut up for them to prevent choking shouldn’t be adorned with small beads that will close off their airways if swallowed. The same babies who shouldn’t be allowed near drapery cords for fear of strangulation shouldn’t have cords draped around their necks.

Why would anyone with a modicum of common sense put an amber teething necklace on a baby?

According to The Natural Mama’s Guide to Amber Teething Necklaces:

Amber teething necklaces are designed to be worn by babies when they are teething. The common belief is that the child’s body heats the amber, causing it to release oils containing succinic acid. The succinic acid, in theory, gets absorbed into the bloodstream, helping to easy baby’s pain…

In theory, when placed around baby’s neck, Baltic amber warms up, causing it to release oils that contain succinic acid. The acid, in turn, gets absorbed through the skin and into the bloodstream.

There’s just two teeny, tiny problems with the theory: Succinic acid ISN’T an effective pain reliever and it ISN’T released from amber beads.

Anyone who isn’t living under a rock knows that there is a tremendous commercial market for pain relievers yet no pharmaceutical company is markets succinic acid as a pain reliever. It is sold for other reasons, however:

Succinic acid is used primarily as an acidity regulator in the food and beverage industry. It is also available as a flavoring agent, contributing a somewhat sour and astringent component to umami taste. As an excipient in pharmaceutical products, it is also used to control acidity or as a counter ion. Drugs involving succinate include metoprolol succinate, sumatriptan succinate, Doxylamine succinate or solifenacin succinate.

So crunchy moms are draping their babies in a choking hazard because it releases a substance used as a food and drug additive. Except that it doesn’t even do that.

According to a scientific abstract looking at release of succinic acid from amber beads.

Infrared spectroscopy was used to confirm that the teething necklaces were made of Baltic amber. The amount of succinic acid contained within the beads was quantified, and succinic acid release from intact beads was measured in phosphate buffered saline (PBS) pH 5.5 or octanol to simulate aqueous or oily skin environments.

RESULTS: Each necklace (33 beads in length) contained 19.17±4.89 mg of succinic acid (mean±se). Over a 6-month period, no succinic acid was detected in PBS, while 0.13±0.09 mg of succinic acid per necklace was released in octanol. Only one replicate of amber beads in octanol released succinic acid, and they had fragmented, with shards free-floating in the solvent.

DISCUSSION: It is likely succinic acid was only detected because the beads were breaking down in octanol, which does not occur when worn around the neck of a child. Furthermore, the hydrophilic properties of succinic acid would not favour its absorption across hydrophobic layers of the skin and into the bloodstream.

CONCLUSION: While the teething necklaces do contain small quantities of succinic acid, it is highly unlikely to be released from intact beads.

So amber teething necklaces not only AREN’T useful for treating teething pain, they COULDN’T be useful for treating teething pain since the active ingredient isn’t released from the beads.

What’s really going on here?

Amber teething necklaces are part of the maternal micro-branding culture. The necklaces offer mothers an opportunity to signal to their allies that they are crunchy and to signal to the mainstream that they are transgressive. They are part of what Alison Phipps calls the “politics of recognition.”

‘Natural’ birth and breastfeeding have become part of an identity package around organic or holistic parenting, while formula feeding and birth interventions (and in particular, caesarean sections) form aspects of a negative Other associated with other practices such as ‘cry-it-out’, vaccination and corporal punishment …

Crunchy mothers may be wrong about the pain relieving properties of deadly amber bead necklaces, but they are correct that such necklaces are a form of micro branding.

Sadly, they brand these mothers as anti-science, gullible and desperate for affirmation.

I received an email from Harry Orf, PhD, Senior Vice President for Research, and Research Integrity Officer Massachusetts General Hospital informing me that I disseminated incorrect information. Much to my regret I repeated false claims and mischaracterized the situation. For that I am deeply sorry and want to correct the record as soon as I can.

How could the original reporter have gotten it so wrong? Where did she come up with these accusations if not from the Harvard investigation?

Let’s look at whom she quotes: all three earn their money from the billion dollar breastfeeding industry. Another leading avatar of the breastfeeding industry, Melissa Bartick, MD, apparently filed the original complaint.

I want to offer a heartfelt apology to Dr. Kleinman for my original piece. I repeated misinformation and for that I am deeply sorry. I’ll be waiting for Bartick, Seals Allers, Sullivan and McEnroe to do the same.

*****

Kudos to Dr. Melissa Bartick for holding leading breastfeeding safety expert Ronald Kleinman, MD to account. He has failed to fully disclose payments from the formula industry.

Now if only she and other lactivists would only hold the Baby Friendly Hospital Initiative to account for iatrogenic brain injuries and deaths as a result of aggressive breastfeeding promotion.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Though Kleinman behaved unethically, there is no question that babies have been injured and died — and continue to be injured and die — on the altar of breastfeeding promotion.[/pullquote]

In 2016, Kleinman and two other physicians co-authored an article published in the highly-regarded peer-review journal, JAMA Journal of Pediatrics, which was viewed as critical of the Baby Friendly Hospital initiative, a global initiative designed to promote better breastfeeding practices in hospital maternity units. Specifically, the study entitled, Unintended Consequences of Current Breastfeeding Initiatives, reported the rooming-in practice, where a baby stays in the same hospital room as the mother at Baby Friendly Hospitals, could, as Time Magazine described, “lead to mothers’ accidentally smothering their children and possibly contribute to sudden unexpected postnatal collapse, a rare but often fatal respiratory failure.”

The revelations could hardly be worse:

At the time, Kleinman failed to disclose his deep financial ties to Mead Johnson, the parent company of Enfamil infant formula, which spanned eight years (2006 to 2014). He had also received an honorarium from Mead for chairing the Mead Johnson Iron Infant Nutrition Panel, funding for a hospital initiative (which he described as a “fruitful partnership”), and was the author of two Mead-funded studies…

Additionally, Kleinman has published at least six articles in the last three years, which some advocates claim are critical of breastfeeding initiatives…

In a more recent article published in the November issue of JAMA Pediatrics critiquing the skin-to-skin guidelines for the Baby Friendly Hospital Initiative, Kleinman disclosed his vast industry connections, including financial ties to the infant formula maker Mead Johnson, General Mills, Ocean Spray and the Alliance for Potato Research and Education (APRE), among others…

Kleinman’s explanation:

In an email response to Women’s eNews, Kleinman responded that his previous failures to disclose his industry connections were an “inadvertent omission.”

What was Dr. Bartick’s role in uncovering Kleinman’s unethical behavior?

I also filed a complaint about Kleinman’s conflicts of interest to the Harvard Medical School Office of Academic and Research Integrity in December 2017, which was never addressed.

Apparently Dr. Bartick was unaware of the investigation that she put in train.

I find Kleinman’s behavior inexcusable for two reasons. First, he deprived other doctors and researchers of relevant information needed to evaluate his papers. Second, by discrediting breastfeeding safety research he puts babies at continued risk of brain injuries and deaths from aggressive breastfeeding promotion.

Make no mistake: though Kleinman behaved unethically, there is no question that babies have been injured and died — and continue to be injured and die — on the altar of breastfeeding promotion.

In taking money from the formula industry, Dr. Kleinman is no different from leading lactivists who take money from the breastfeeding industry. The payments he received are no more or less likely to affect his research conclusions than the payments from the breastfeeding industry affect the conclusions of lactivist.

Moreover, financial conflicts of interest and not the only conflicts of interest that can affect breastfeeding research. White hat bias is equally if not more important. Indeed, breastfeeding research was identified as a paradigmatic example of white hat bias in the seminal commentary by Cope and Allison, White hat bias: examples of its presence in obesity research and a call for renewed commitment to faithfulness in research reporting.

‘White hat bias’ (WHB) [is] bias leading to distortion of information in the service of what may be perceived to be righteous ends… WHB bias may be conjectured to be fuelled by feelings of righteous zeal, indignation toward certain aspects of industry, or other factors. Readers should beware of WHB and … should seek methods to minimize it.

Cope and Allison note that researchers have been so anxious to establish a connection between formula feeding and obesity that they have ignored or misrepresented what the scientific evidence actually shows.

Certain postulated causes have come to be demonized (… formula feeding of infants) and certain postulated palliatives seem to have been sanctified…

Whether WHB is intentional or unintentional, stems from a bias toward anti-industry results, significant findings, feelings of righteous indignation, results that may justify public health actions, or yet other factors is unclear. Future research should study approaches to minimize such distortions in the research record…

I suspect that it is white hat bias — feeelings of righteous indignation toward the formula industry — that lead lactivists like Prof. Amy Brown to make irreponsible claims that she is subsequently forced to withdraw.

Earlier this week, Brown tweeted:

There is a misleading post circulating suggesting a newborn’s stomach is larger than medical textbooks say it is. It suggests that the volume at 40 weeks could be 33ml rather than approx 7ml. Based on this it incorrectly claims colostrum is not enough and top ups are needed.

It was repeatedly brought to her attention that the size of 7 ml comes from a 1920 paper that has been superceded by multiple recent papers that show a newborn stomach size of 20-30 ml. Brown refused to back down until she was shown this excerpt from a pediatric surgery text:

[Stomach] size increases rapidly from 30 ml in a term baby to 100 ml by the fourth week.

Brown responded:

Ranges seem to go from 5-30 which happy to accept. But again … stomach size is irrelevant…

But if it were irrelevant she wouldn’t have created a Twitter thread attempting to discredit the true size. The lactation profession has spent at least a decade attempting to normalize infant starvation by insisting that colostrum must be enough to assuage infant hunger because infant stomach size is too small to require larger amounts. That has always been a lie.

Why lie about newborn stomach size? It may be the result of the financial conflict of interest of lactation professionals who make their money by promoting breastfeeding. It almost certainly the result of white hat bias in the form of a near irrational hatred of the formula industry that has led to the irresponsible claim that formula supplementation destroys the breastfeeding relationship when the scientific evidence shows the exact opposite.

So thank you Dr. Bartick for doing the strenuous work required to hold another physician to account for his egregious failure to disclose his conflicts of interest. Now may I suggest that you perform a similar service by holding the breastfeeding industry to the same high standard. Because though Kleinman behaved unethically, there is no question that babies are being injured and are dying from aggressive breastfeeding promotion.

A new paper in Clinical Pediatrics, Umbilical Cord Nonseverance and Adverse Neonatal Outcomes, reports on babies harmed by the bizarre practice of lotus birth.

Lotus birth is the latest fad in the world of birth performance art.

It used to be that women got pregnant with the intention of having a baby. In 2018, among a certain segment of privileged, white natural childbirth advocates, the performance is the point. For example, freebirth, childbirth without medical assistance of any kind, is a stunt. As such, the baby is merely a prop and an expendable prop at that. According to freebirther Desirea Miller:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lotus birth is a bizarre practice with no medical benefit and considerable risk, particularly the risk of massive infection. [/pullquote]

A live baby is usually the goal. Not everybody has that same goal but if that’s your goal, there’s no shame in going [to the hospital] to get checked.

Lotus birth is another fringe stunt beloved of those who think bragging rights are more important than a healthy baby. It is the decision to leave the placenta attached to the baby for several days until it rots off. It’s an affectation with no medical benefit and considerable risk, particularly the risk of massive infection.

According to Lotus Fertility.com (“Serving your Inner Midwife”):

…[T]he placenta is placed in a special bowl or wrapped in a ceremonial cloth (it is helpful to rinse it first, and remove clots)… Sea salt is also applied generously on both sides to aid drying and minimize scent. This small pillow and its cord are easily kept with the baby, and some women even use the Lotus pillow as an elbow prop during nursing…

Why would anyone leave a dead chunk of meat attached to her baby?

The practice … [is] called “Lotus Birth”, connecting the esteem held in the east for the Lotus to the esteem held for the intact baby as a holy child … Ahimsa, (non-violence in action and thought within one’s self and towards others) … is from the writings and leadership by Gandhi … and Martin Luther King, Jr.’s civil rights inspired marches followed soon after. Approaching birth options with Ahimsa in mind is something that can create a tremendous liberation of creative energies, freeing the potential of birth & early parenting to be a peaceful experience for the human family at large…

In other words, lotus birth is New Age nonsense … but it is also potentially deadly to the baby. As the authors of the new scientific paper explain:

Because of the potential for decomposing placental tissue to become a nidus for infection, and in the absence of medical evidence describing a benefit of this practice, the United Kingdom’s Royal College of Obstetricians and Gynaecologists has issued a statement advising women about the lack of evidence to support UCNS as a safe procedure. The American College of Obstetricians and Gynecologist and the American Academy of Pediatrics do not recommend UCNS. One existing case report has linked UCNS with persistent neonatal hepatitis. Another has linked UCNS to a case of Staphylococcus epidermidis neonatal sepsis.

The authors describe a baby rendered critically ill by a heart infection apparently contracted from the decomposing placenta:

A 20-hour-old male infant with UCNS was brought to the emergency department by his parents for labored breathing. The parents reported that the infant was born at home via water birth with spontaneous, prolonged rupture of membranes (>18 hours). No resuscitation was required at birth…

He was admitted to the neonatal intensive care unit (NICU) due to concern for sepsis. Ampicillin and gentamicin were started empirically. At 30 hours after admission, the blood culture was positive for coagulase-negative Staphylococcus; the umbilical cord was then cut, and central lines were placed for continued antibiotic therapy… The second blood culture grew Staphylococcus lugdunensis…

The infection was so serious that the bacteria was growing in the baby’s blood. S. lugdunensis is a common skin bacteria that can gain access to the baby’s bloodstream through a skin infection (which this baby did not have) … or through direct communication of a rotting placenta with a baby’s circulation.

Even more ominous:

An echocardiogram (ECG) was ordered on hospital day 4 because of the association of S lugdunensis with endocarditis. The ECG revealed tricuspid valve leaflet thickening and presence of a vegetation [colony of bacteria] …

It took 6 weeks of hospitalization for IV antibiotics to cure the heart infection. Fortunately the baby appears to have escaped permanent damage to his heart valve and the associated disability.

In trying to recapitulate birth in nature, the mother had a homebirth. This “natural” birth led to the baby experiencing nearly every possible serious medical intervention in a 6 week hospital stay.

As the authors of the paper note:

Ironically, families seeking a more natural birth option may end up getting a more invasive experience than a family choosing standard delivery and newborn care.

The ultimate irony is that there is nothing natural about lotus birth. There are no primates, nor human cultures in which the placenta is left attached to a newborn. Lotus birth is a thoroughly modern affectation, one with potentially deadly consequences.

They created the surgical procedure with the best of intentions. They wanted to prevent serious problems and it seemed to them the best way to do it. Unfortunately they were wrong and a lot of unnecessary suffering was the result.

I’m talking about episiotomy, but I could be talking about painful newborn tongue-tie surgery.

How did good people get things so wrong?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]If you wouldn’t willingly undergo a painful episiotomy because it “might” be helpful, don’t force your baby to undergo painful tongue-tie surgery because it “might” improve breastfeeding.[/pullquote]

Episiotomy was created to prevent both short term and long term complications of childbirth. Episiotomy was created on the theory that a controlled tear made by a scissors would create enough room at the vaginal opening so that the baby’s head would not tear it further down to the anal sphincter (3rd degree tear). The theory made sense.

It was also designed to prevent serious long term complications of childbirth like uterine prolapse and urinary incontinence. That theory made sense, too.

Unfortunately, both theories turned out to be wrong. Not only did episiotomy fail to prevent uterine prolapse and urinary incontinence (which are cause by weakening of muscles far above the vaginal opening) but — in an ugly irony — cutting an episiotomy actually made 3rd and 4th degree tears MORE likely.

Once routine, episiotomy is now recognized as only appropriate in some very specific situations such as the use of forceps.

Tongue-tie surgery was also created with the best of intentions.

What is tongue-tie?

If you look carefully at the photo above, you will see that underneath the infant’s tongue there is a small vertical membrane that connects the tongue to the floor of the mouth. Tongue tie occurs when the membrane (the frenulum) is abnormally shortened and or thickened, restricting the movement of the tongue itself. Since the motion of the infant tongue is critical in breastfeeding, it’s easy to see how tongue-tie can cause problems breastfeeding.

Signs and symptoms of tongue-tie include:

• Difficulty lifting the tongue to the upper teeth or moving the tongue from side to side
• Trouble sticking out the tongue past the lower front teeth
• A tongue that appears notched or heart shaped when stuck out

The natural incidence of tongue-tie has been estimated as 1.7-4.8%.

There has been a recent dramatic surge in tongue-tie surgery. According to lactation consultant Nancy Mohrbacher:

What started as a problem for a small percentage of babies seems now to be an epidemic. Health-care providers report increasing numbers of breastfeeding mothers self-diagnosing tongue and lip ties in their babies, often based on online information, and asking for a tongue- or lip-tie revision …

The surgery can be very painful for babies, leading to a large open wound beneath the tongue as this photo shows:

Think about how painful biting your tongue it; now imagine a gaping wound like that. Some babies who have undergone tongue-tie surgery have developed oral aversion. Breastfeeding (and even bottle feeding) are associated with so much pain that the babies refuse to eat even after the wound has healed.

The worst part is that — like episiotomy — tongue-tie surgery doesn’t work as this 2017 paper in Breastfeeding Review explains.

A 2014 systematic review by Power and Murphy concluded that half of breastfeeding babies with tongue-tie will not have problems. If there were difficulties, mothers reported improvements after frenotomies or frenectomies. But the authors note that it is difficult to determine how much of this effect is placebo.

A 2015 systematic review by Francis, Krishnaswami and McPheeters concluded that a small body of low to insufficient quality evidence indicates that frenotomy is associated with mother-reported improvements in breastfeeding and nipple pain, noting that the studies are short-term and of inconsistent methodology.

Even worse, the surgery is now being recommended in the absence of classic tongue-tie for conditions known as “posterior tongue-tie” upper lip-tie. Supposedly, these ties cause reflux due to air swallowing. As physician/lactation consultant Pamela Douglas notes:

…[T]here is no reliable evidence that the diagnoses of posterior tongue-tie and upper lip-tie are meaningful or useful for breastfeeding pairs.

And:

…[T]he hypothesis that reflux is caused by excessive air swallowing in infants with poor latch due to posterior tongue-tie and upper lip-tie … lacks credible physiological mechanisms or supporting evidence… This article argues that our breastfeeding women and their babies deserve the most rigorous scientific methods available, and acknowledgment of the biases inherent in less rigorous research, if we are … to prevent unnecessary oral surgery.

Tongue-tie surgery — like episiotomy — is appropriate in certain specific situations such as classic anterior tie that prevents a baby from moving her tongue to her teeth (and may contribute to future speech impairment).

But tongue-tie surgery is big business and its practitioners promote it. The surgical fee for frenectomy/frenotomy is $850. I presume that $850 is what the doctor bills; what he or she is actually paid probably varies by insurance company. Those mothers who don’t have health insurance may be forced to pay the entire fee out of pocket.

Why has there been a dramatic increase in the diagnosis of tongue-tie and a dramatic increase in expensive surgery to correct it?

Dr. Bobby Ghaheri insists that Diagnosing Tongue-Tie In A Baby Is Not A Fad:

One of the most frequent things I hear is that primary care providers say something to the effect of “Oh, diagnosing tongue-tie is just a fad” or “This tongue-tie business is just something new that some people are doing”.

So if pediatricians and ENT specialists think most tongue-tie surgery is unnecessary, who’s making the diagnoses? Mothers and lactation consultants.

Is tongue-tie surgery the new episiotomy?

I’m afraid it it. It’s a painful procedure created with the best of intentions, useful in certain specific circumstances, but it has become widespread without solid evidence that it works.

So if you wouldn’t willingly undergo a painful episiotomy because it “might” be helpful, don’t force your baby to undergo painful tongue-tie surgery because it “might” improve breastfeeding.

Vision. It’s arguably the most important of our 5 senses.

It allows us to see a grain of salt, a mountain in the distance and everything in between. It is the key to game hunting, to precision manufacturing, to hitting a home run. It is 100% natural. All human beings are “designed” to see.

Curiously, despite the centrality of vision to our existence and despite the fact that it is natural, the incidence of poor vision is extraordinarily high. Approximately 30% of Americans are nearsighted; approximately 30% of Americans are farsighted; an equal proportion of Americans suffer from astigmatism. These impairments of vision can occur alone and in combination. Indeed, there are many people over age 40 who are both nearsighted, farsighted and have astigmatism.

[pullquote align=”right” color=””]If vision – a critical bodily function – could require technological assistance more than 50% of the time, why couldn’t lactation also require technological assistance? [/pullquote]

What does that tell us?

It tells us that even critical natural functions don’t work properly a large proportion of the time.

It tells us that lactivists like Prof. Amy Brown have literally no idea what they are talking about when they offer claims like this:

There’s a difference between dying from external causes and a part of the body simply not working across a species.

Over 60% of Americans use glasses for vision correction. Nearly 20% use contact lenses for vision correction. That sounds suspiciously like a part of the body — a vital part of the body —simply failing across a large proportion of the species.

If vision – arguably as important as breastfeeding — could require technological assistance more than half the time, why couldn’t lactation also require technological assistance?

We can take the analogy even further:

Are people who need glasses — who have eyes designed to see — not trying hard enough to see? Of course not.

Are they victims of relentless propaganda from Big Glasses and don’t really need vision correction at all? That’s absurd!

Are people who use glasses or contact lenses “giving in” to the inconvenience of not being able to see? How ridiculous!

What about the impact of “unnatural” glasses and contact lenses?

Does a book written by someone wearing reading glasses have less merit than one written by someone with 20/20 vision? No.

Is a touchdown pass drilled to the receiver by a quarterback wearing contact lenses not really a touchdown? No.

If a nearsighted climber summits Mount Everest wearing glasses, is it a lesser achievement than if she had done the same thing without glasses? Absolutely not.

Why not? Because we judge achievements by the outcome, not the process. It makes no difference if someone needs vision correction to complete their activities of daily living or to fulfill their wildest dreams. The achievement is not marred by the need for vision correction.

And, critically, not needing vision correction is not, in and of itself, an achievement.

The same arguments can be made about breastfeeding. Yes, it’s natural. Yes, women are “designed” to breastfeed. Nonetheless a substantial proportion of women and babies will have difficulty with breastfeeding.

Are women with insufficient breastmilk not trying hard enough? Of course not.

Are they victims of relentless propaganda from formula companies and don’t really need to supplement their babies at all? That’s absurd!

Are women who don’t breastfeed abnormal or unnatural? No.

Are woman who choose to formula feed “giving in”? Hardly.

Are babies nourished with formula any less intelligent, talented or valuable than babies nourished with breastmilk? Of course not.

Is raising that baby into a healthy happy child with formula any less of an achievement than doing the same with breastmilk? That’s absurd. The achievement is the healthy, happy baby, not the breastfeeding.

The bottom line is that a home run with vision correction is better than a strikeout without it. A healthy formula fed toddler is better than a stunted toddler who is breastfed.

I understand that there are women who want to view unmedicated breastfeeding as an achievement, but that says more about them and their fragile self-esteem than it says about childbirth or breastfeeding.

I also understand that lactivists like Dr. Amy Brown not only have limited understanding of human physiology, they appear to have no understanding of evolution.

It is the outcome that counts. A great outcome is infinitely more important than a natural process whether that process is vision or lactation. That’s why Fed Is Best!

One of the most distressing things about breastfeeding advocates is the cavalier way in which they dismiss the suffering of starving babies. It bears an uncomfortable resemblance to the way that drug companies cavalierly dismiss the suffering of patients when they learn of deadly side effects of medication. Both promote profits ahead of people.

For example, Vioxx is a non-narcotic medication that had dramatic benefits for a certain population of pain sufferers and, as a result, was a reliable money maker for Merck. But it also had serious side effects that Merck tried to hide in an effort to maintain market share. Merck lied and patients died.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The breastfeeding industry continues to lie and babies continue to suffer brain injuries and die.[/pullquote]

That’s how you can tell the difference between medical professionals and businesses. When real medical professionals learn about harm from their recommendations, they investigate and try to mitigate that harm. When businesses learn about harm from their recommendations, they issue denials that misrepresent or lie about the scientific evidence.

Breastfeeding is a biological process with small benefits for term babies, but because of exaggeration it has become a reliable money maker for the breastfeeding industry of lactation consultants, La Leche League and the Baby Friendly Hospital Initiative among others. But it also has serious side effects that the breastfeeding industry is trying to hide to maintain market share. The breastfeeding industry lies and babies die.

Consider the latest lie from lactivist Prof. Amy Brown, a psychologist by training who has no education in physiology:

#1 There is a misleading post circulating suggesting a newborn’s stomach is larger than medical textbooks say it is. It suggests that the volume at 40 weeks could be 33ml rather than approx 7ml. Based on this it incorrectly claims colostrum is not enough and top ups are needed.

#2 There are many things wrong with this. These figures are taken from 1 baby during an ultrasound. They measure an emptier stomach and then the stomach 15 mins later when the baby has swallowed amniotic fluid. Scientists do not make decisions based on 1 baby or 1 set of measures

Brown’s lie is chilling on a variety of levels.

1. A real medical professional would start by reviewing the scientific literature on neonatal gastric capacity. A business person more concerned about profits than people would ignore the scientific literature as Brown has done.

Here’s what the scientific evidence shows:

This chart comes from a literature review published in Acta Pediatrica in 2013. You can see that the average stomach size was found to be anywhere from double to nearly quintuple the size quoted by lactation consultants.

The lactivist claim is based on a study from 1920 by Scammon and Doyle that has clearly been discredited by seven studies done since then. The average size of the newborn stomach is NOT 5-7 cc but closer to 20 cc, rising dramatically over the first first days. And some babies need every one of those 20 cc per feeding and more.

2. A real medical professional would review the scientific literature for reports of breastfed babies being underfed (case reports). A business person more concerned about profits than people would ignore the scientific literature as Brown has done.

Even a cursory examination of the scientific literature reveals multiple case reports of babies suffering brain injuries and death from hypernatremic dehydration, hypoglycemia, hyperbilirubinemia, known manifestations of infant underfeeding. Brown either does not know or does not care.

3. A real medical professional would consult the scientific literature on the incidence of underfeeding among breastfed babies. A business person more concerned about profits than people would ignore the scientific literature as Brown has done.

Had Brown bothered to read the scientific literature, she would find quite a few papers on the risks of breastfeeding.

Health Care Utilization in the First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding by Flaherman et al. was published earlier this year. The results are startling.

We had data on inpatient feeding for 105,003 (96.6%) vaginally delivered newborns and 34,082 (97.0%) delivered by Cesarean. Among vaginally delivered newborns, readmission after discharge from the birth hospitalization occurred for 4.3% of those exclusively breastfed during their birth hospitalization and 2.1% of those exclusively formula fed during their birth hospitalization (p<0.001)… For Cesarean births, readmission occurred for 2.4% of those exclusively breastfed during the birth hospitalization and 1.5% of those exclusively formula fed during the birth hospitalization (p=0.025)…

In addition to the pain and suffering of the newborns and anguish of the parents, a tremendous amount of money was spent.

…[S]ince the cost of a neonatal readmission has been estimated at $4548.27 a potential savings of $7.8 million might be realized for a cohort similar to ours if the readmission rate of exclusively breastfed newborns approximated that of newborns exclusively formula fed.

To put that in perspective, with 4 million births each year and more than 75% hospital breastfeeding rates, that means we should expect 60,000 excess newborn hospital admissions at a cost of more than $240,000,000 each and every year — nearly a quarter of a billion dollars. And that doesn’t even count the downstream impact of brain injuries, a consequence that was beyond the purview of this study.

The study Efficacy of Subthreshold Newborn Phototherapy During the Birth Hospitalization in Preventing Readmission for Phototherapy was undertaken to determine whether prophylactive phototherapy could reduce the risk of hospital readmission for severe neonatal jaundice.

Phototherapy does work, but the authors serendipitously found a far simpler intervention that also dramatically reduces the risk of readmission: formula! Infants allowed unrestricted access to formula had a 76% reduction in risk of readmission.

So we have multiple scientific papers that show that newborn stomach capacity is far greater than what lactivists claim, multiple scientific case reports of babies harmed by underfeeding, and a variety of scientific papers that show that aggressive breastfeeding promotion accounts for tens of thousands of newborn hospital readmissions each year at a cost of hundreds of millions of dollars.

Who benefits by lying about that scientific evidence? It’s not babies since they are clearly harmed, sometimes even killed, by the insistence that newborn stomach size is so small that babies can’t possibly be underfed. It certainly isn’t mothers since they are clearly harmed by their babies screaming from hunger, readmitted to the hospital and sustaining brain injuries or even dying because they have been unwittingly underfed. The ONLY people who benefit from lying about newborn stomach size are those who make their money promoting breastfeeding … and that’s why they continue to lie.

The makers of Vioxx could have salvaged quite a bit had they been honest about the potentially deadly side effects of the drug. Alerting doctors and patients would have allowed them to consider the risk and the fact that the benefits might clearly outweigh the risk. But the drug company was afraid that the truth that Vioxx wasn’t perfect would lead to a tremendous fall off in market share so they lied. Eventually they were caught in those lies and they paid a massive financial price, but that didn’t bring back the patients who had already suffered and died.

Breastfeeding advocates could salvage quite a bit if they were honest about the potentially deadly risks of breastfeeding. Alerting providers and patients to the true newborn stomach size and counseling them to look for and treat underfeeding would allow them to consider the risks and the fact that for many women the benefits might outweigh the risk. But breastfeeding advocates are afraid that the truth that breastfeeding is not perfect would lead to a tremendous fall off in market share so they lie. They are already being caught in those lies, although I doubt they will pay any price for their lying. In the meantime babies and mothers continue to suffer and die … while breastfeeding advocates continue to profit.

Two articles on breast cancer risk were published this week and they provide a window on the politics of breastfeeding.

The first paper is Learning, Life, and Lactation: Knowledge of Breastfeeding’s Impact on Breast Cancer Risk Reduction and Its Influence on Breastfeeding Practices.

It received a fair amount of press, including articles like Study finds doctors aren’t telling moms about breastfeeding’s cancer protection:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Promoting breastfeeding as reducing breast cancer risk is yet another inappropriate attempt to pressure women.[/pullquote]

When it comes to reducing women’s risk of breast cancer, epidemiological studies connect breastfeeding beyond the baby’s first year with a lower chance of developing triple-negative breast cancer.

That news isn’t getting out enough, according to a survey of 724 women from the Ohio State University Comprehensive Cancer Center. It found that although almost 60 percent of breastfeeding mothers knew their risk of cancer was reduced, only 16 percent said they got the news from health care providers.

The lead author, Bhuvana Ramaswamy, apparently a rabid lactivist, had this to say:

“There’s so much effective marketing by Nestle about infant formula,” she added. Hospitals still don’t always support early breastfeeding efforts, she said.

“Often mothers are told, ‘We can room the baby in the nursery, so you can get a good night’s sleep,’” she said. “They’re bottle-grooming the baby at the start.”

Bottle-grooming? Seriously? Are lactivists analogizing bottle feeding to sexual predation now?

What is the magnitude of this reduction in breast cancer risk? According to the widely cited study by Horta et al.:

The largest individual-level analysis on this topic included about 50000 patients with cancer from 47 studies,30 which is about half those included in our meta-analysis. Each 12-month increase in lifetime breastfeeding was associated with a reduction of 4·3% (95% CI 2·9–6·8) in the incidence of invasive breast cancer.

So Dr. Ramaswamy believes that it is imperative to make women aware of a 4.3% decreased risk of breast cancer because it is yet another factor that will convince women to breastfeed.

The second paper that was recently published is Breast Cancer Risk After Recent Childbirth: A Pooled Analysis of 15 Prospective Studies. The authors found:

Compared with nulliparous women, parous women had an HR for breast cancer that peaked about 5 years after birth (HR, 1.80 [95% CI, 1.63 to 1.99])…

Compared with nulliparous women, parous women have an increased risk for breast cancer for more than 20 years after childbirth. Health care providers should consider recent childbirth a risk factor for breast cancer in young women.

As a New York Times article explains:

…[I]n women between the ages of 41 and 50 who had given birth in the previous three to seven years, the study found that 2.2 percent developed breast cancer, while in those who had not had babies, the figure was 1.9 percent.

That’s an increased risk of 16%.

But don’t worry; that risk is still low.

[R]esearchers said that the findings should not influence women’s decisions about if or when to have children.

See the paradox?

Childbirth increases breast cancer risk by 16% in the short term, but that risk should not influence women’s decisions about if or when to have children.

Yet, breastfeeding decreases the risk of breast cancer by 4.3% and women should strongly consider that in making a decision about whether to breastfeed.

On the face of it, these opposing approaches make no sense. Even with a 33% increased short term risk of breast cancer, the actual number of breast cancer cases is so small that it should not be a factor for women in determining whether to have children. Obviously a 4.3% reduction in breast cancer risk as a result of breastfeeding is far smaller still. Therefore, it should not be a factor for women in determining whether or not to breastfeed.

In truth, a woman’s risk of breast cancer is complex and multifactorial and childbearing and breastfeeding are two relatively minor modifiers of risk. But in the world of breastfeeding promotion, any benefit no matter how small is exaggerated and celebrated as a reason to pressure women to breastfeed.

Taken together these studies illustrate how risk is emphasized or ignored based on researchers’ priorities, not based on reality. Promoting breastfeeding as reducing breast cancer risk is yet another inappropriate attempt to pressure women into breastfeeding. If anyone is engaged in grooming, it is lactation professionals who routinely mislead women about the benefits of breastfeeding, elide its risks and remain utterly dismissive of the harm that pressure to breastfeed causes both babies and mothers.

Are you one of those who think that Nature gave a woman breasts, not that she might feed her children, but as pretty little hillocks to give her bust a pleasing contour? Many, indeed, of our present-day ladies do try to dry up and repress that sacred fount of the body, the nourisher of the human race, … lest it should take off from the charm of their beauty.

It may be a bit flowery, but the quote accurately expresses the anxiety of contemporary lactivists over the sexualization of breasts leading women to ignore their most important function, providing milk for newborns.

Therefore, you may be surprised to learn that the quote comes from Rome in AD 150.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The lactivist project is dystopian in its efforts to indocrinate, regulate and measure the behavior of women.[/pullquote]

How about this quote bemoaning the fact that rich mothers refuse to breastfeed while poor mothers do so eagerly?

Most mothers of any condition either cannot or will not undertake the troublesome task of suckling their own child… The Mother who has only a few Rags to cover her Child loosely, and little more than her own Breast to feed it, sees it healthy and strong, and very soon able to shift for itself; while the puny Insect, the Heir and Hope of a rich Family lies languishing.

That’s William Cadogan writing in 1750.

Or this quote about indigenous women, closer to nature, and therefore better able to nurture their infants.

The ideal nursing mothers are the cow among animals and the peasant mother among our own kind, who do not think about it all, but get on with the job, and in this matter an ounce of faith is worth a ton or more of science and book-lore.

Lindsey W Batten writing in 1838.

Indeed, as Pam Carter notes in her chapter Breast Feeding and the Social Construction of Heterosexuality, or ‘What Breasts are Really for’ from the book Sex, Sensibility and the Gendered Body the purported conflict between the sexualization of breasts and the proper use of breasts has been going on for at least two millennia and probably far longer:

While some attribute this conflict to ‘Hollywood’ or ‘modern civilisation’ it is clear that it has earlier manifestations within Western culture.

It has little to do with what benefits babies. The anxiety about breastfeeding reflects the anxiety about the role of women within society.

Concern about breast feeding constitutes concern about women’s behaviour… At the heart of the breast feeding ‘problem’ is a preoccupation with the failure of women to use their breasts in ways which are deemed natural…

Sound familiar? It should; I’ve been writing the same thing for years.

How dare I (or anyone) question the benefits of breastfeeding? According to lactivists, anyone who questions breastfeeding must hate breastfeeding.

But as Carter suggests:

Perhaps the fact that raising questions about such a taken-for-granted good thing looks like a hostile act should alert us to an arena which warrants further scrutiny.

Breastfeeding is a proxy for attitudes about women’s emancipation from stay at home motherhood.

…Despite the preoccupation in the breast-feeding literature with the inadequate behaviour of women, there is almost no recognition that breast feeding is constructed within gendered social relations. Women are always present within discussions about breast feeding but are presented as unproblematic natural beings. In that respect women are strangely invisible…

There is an assumption that breast feeding is always in women’s interests, that in itself it is a form of resistance to patriarchy. But there is little attempt to look at breast feeding from the point of view of women themselves nor at the impact of the powerful linkages which are made between good mothering and breast feeding. There are limited opportunities for women to articulate a different perspective…

One sentence from the chapter struck me forcefully:

So the naturalness of breast feeding is endorsed by science and controlled by medicine through various surveillance techniques.

What is the Baby Friendly Hospital Initiative if not an attempt to control women’s behavior through various surveillance techniques? The contemporary lactivist project is dystopian in its efforts to indocrinate, regulate and measure the behavior of women.

It is dystopian in its use of public shaming — mandatory visits of lactation consultants, formula consent forms, and public condemnation of bottle feeding.

It is also dystopian in that it flagrantly ignores — indeed denies the existence of — the harms to babies physical health and women’s mental health from equating breastfeeding with good mothering.

We are encouraged to imagine — with no evidence whatsoever — that a society in which every woman breastfeeds is a better society but the key question is never asked, let alone addressed. Better for whom?

Controlling women by controlling their breasts is not better for babies and it’s not better for mothers. It is only better for those who want to keep women in their traditional, biologically determined, misogynistic place.

Yesterday I wrote about the tendency of anti-vax mothers to view themselves as heroes. Though they view themselves as rebelling against “the system,” the truth is that they are merely submitting to a different system, characterized by deeply valued fantasies including the illusion of control of the health of their children and the radical uniqueness of their children, almost always in conjunction with ignorance of science, medicine and statistics.

While researching for that post I came across a fascinating book, The Paradox of Natural Mothering By Chris Bobel, an associate professor of Women’s Studies. In Bobel’s view, natural mothering isn’t just a paradox, it is a plethora of paradoxes:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Though natural mothers imagine themselves as transgressive advocates for social change, in reality they are both privileged and self-absorbed.[/pullquote]

It is a movement of radical simplicity that promotes rabid consumerism … albeit for non-traditional products.

It venerates a highly romanticized “natural” form of parenting that not only was never practiced by our foremothers, but is thoroughly modern.

It stresses feminist empowerment through total submission to a traditionally gendered division of labor.

It isn’t so much a paradox as it is an oxymoron.

Natural mothering may resist certain capitalist and technological prescriptions for family life, but it does not resist essentialized, even romanticized, conceptions of women that manifest themselves in a rigid sexual division of labor.

In truth, natural mothering reflects the three P’s: purchasing, patriarchy and privilege.

Purchasing

Bobel notes:

For many of the natural mothers, consumerism is a key feature of what they regard as mainstream culture. Typically, natural mothers perceive themselves as fervent critics of American consumption practices. They assert that every individual must make a pledge to live simply if the planet and its inhabitants are to survive. Moreover, consumerism sustains the capitalist system, which is increasingly dependent on mothers who work outside the home. When a mother refuses to “buy into” the notion that her worth is established by a paycheck or a job title, she performs an act of resistance. Furthermore, when she is home, she is “freed up” to construct a lifestyle less dependent on the goods and services designed to assist overly busy people who do not have time to cook, sew, garden, and build.

The irony is that there is virtually no aspect of natural mothering that does not require the purchase of expensive products and services. As sociologist Norah MacKendrick explains in her paper More Work for Mother; Chemical Body Burdens as a Maternal Responsibility:

The ideology of intensive mothering infuses spaces of consumption by urging mothers to buy with the best interests of the child in mind. Consumption is therefore entangled with other routine activities that parents — and mothers in particular — view as integral to securing a child’s future outcomes. Indeed, women’s transition to motherhood is marked by the consumption of specific material goods…

Eggs must be cage-free, clothes must be unbleached cotton and homeopathic treatments must be devoid of GMO’s. And all of it must be organic and therefore quite expensive. Natural childbirth requires a midwife, doula and rented inflatable tub, not to mention books and courses. Breastfeeding requires a lactation consultant, lactation cookies, herbal supplements and specialized clothing designed for ease in breastfeeding. The list of products that are required for radical simplicity is quite long and constantly growing.

It’s difficult to avoid the conclusion that natural mothering, touted as a rejection of contemporary consumer culture, is merely a niche form of the very same consumer culture that is purportedly being rejected. In other words, just as the women who feed their children McDonald’s take out, let them play with plastic toys, and allow them to watch TV are obviously responding to rampant consumerism, natural mothering advocates who hire doulas, treat everything with homeopathic remedies, and wear their babies in slings are unwittingly responding to the exact same consumerism they claim to deplore, carefully curated to appeal specifically to them.

Patriarchy

As Bobel explains in the section Putting Family First and Mom Last: Natural Mothering and Accommodating Patriarchy, natural mothering requires an almost complete capitulation to the misogyny of the patriarchy:

…[N]atural mothers do not resist patriarchal constructions of motherhood. While they make the fairly radical claim that female productivity must be ascribed social value, they do not resist the most fundamental assumptions about what it means to he a woman in the contemporary age. Natural mothering, rooted in biologically determinist understandings of gender, reifies a male-centered view of role-bound women. The “natural” in natural mothering may liberate mothers from a mechanized and commodified experience of their maternity, but it reproduces a gendered experience that subordinates their needs to those of child and husband and models that experience for their children…

Natural mothering, then, adapts to patriarchal notions about women and men, including … the preeminence of biology as shaper of human destiny. It accepts a standard that rationalizes women’s inferior social position…

Women are taught to seek “feminist” empowerment through submission to traditional gender norms.

Privilege

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. That’s why unmedicated vaginal birth is an “achievement” for a suburban white women, but not for a woman of color living in an African village without access to epidurals.

Moreover:

Natural mothers … enjoy a privileged position in which their alternative lifestyle is possible. That is, it is because they enjoy a secure economic status, solidified by their racial, educational, and class status, that they can afford to take the social risks involved in nonmainstream practices. In this sense, their privilege serves as a sort of safety net, protecting them from a nasty fall should they, for instance, he challenged for nursing their toddler in a public place or refusing conventional medical treatment for an illness. Being white and middle-class, they are less likely to come under attack. A poor woman of color spotted breastfeeding an older child could risk censure and certainly judgment. A mother receiving state benefits is required to vaccinate her children; waiving vaccinations is not an option. An immigrant woman known to use herbal remedies to treat illness risks a scolding by her family physician.

Though natural mothers imagine themselves as transgressive advocates for social change, in reality they are both privileged and self-absorbed.

The most striking thing about the paradigm of natural mothering as a politicized lifestyle is the specific way in which it is realized. Rather than taking to the streets, running for local office, or dedicating their lives to grassroots community organizing, these women strive to effect social change through the day-to-day practice of mothering outside the mainstream.

But they are not effecting social change, they are reifying their own privilege and passing it on to their children to the exclusion of other children.

Natural mothering — promoted as radical simplicity, parenting just like our foremothers and offering feminist empowerment — is in fact the complete opposite. It is a form of consumerism, confirms traditional misogynistic gender roles, and reflects and reinforces privilege.

A new paper in Clinics in Mother and Child Health, Intensive Mothering and Vaccine Choice: Reclaiming the Lifeworld from the System, provides fascinating insight into how anti-vaccine mothers view themselves.

What brings families to the decision to delay or refuse vaccination? What informs their choices? How do vaccination choices fit into broader trends in pregnancy, birth, and childrearing?

Anti-vax mothers believe:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]She is a superhero keeping her child safe from corrupt experts shilling for greedy corporations.[/pullquote]

[S]ome mothers “have wrested control of their personal lives away from institutions and experts and others who claim to ‘know best’ and returned it to the site of the individual family…this hard­won control does not rest with the individual; rather, it is surrendered to nature. The natural mothers exalt nature as a force to be trusted and respected.”

Of course we are not talking about all mothers. Privilege is the sine qua non of natural mothering. But for these women:

In our current milieu, the good mother is an intensive mother;… intensive mothers often tend toward holistic, natural styles of care over efficient and scientized approaches to family management and decision making. While not all intensive mothers are natural mothers, we suggest a connection between the centering of children’s needs and desires of intensive mothering, paired with prioritization of naturalness and distrust of the medical system, come together …

As I have argued repeatedly in the past, natural mothering reflects a new domesticity as well as submission to traditional gender roles. The natural mother has no time to work since she has been convinced that her “work” is keeping her child safe in a dangerous world filled with evil experts who are merely shills for industry, engaging in profitable efforts to harm children.

…Natural mothers choose to dedicate their full attention to intensive mothering, but are marked by three specific elements including a commitment to simple living, attachment parenting, and cultural feminist theory. Natural mothers use their “intuition as a practical guide, […] their notions of mothering at odds with mainstream notions about the proper way to raise a family.”.

The natural intensive mother exists in contradiction to the “bad other mother” who “goes with the flow of the mainstream, doesn’t question conventional wisdom, ignorant, duped by powerful, child hostile, expert and institution dependent culture.”. Natural intensive mothers are parenting from an individualist approach; prioritizing their children’s needs within institutions and advocating for them when necessary. To do so successfully, parents invest a significant amount of time into the labor of knowledge consumption and research, talking with friends and family, sharing information online and on the internet, all while centering their children’s uniqueness.

They are heroes!

Though they view themselves as rebelling against “the system,” the truth is that they are merely submitting to a different system, characterized by deeply valued fantasies including the illusion of control of the health of their children and the radical uniqueness of their children, almost always in conjunction with ignorance of science, medicine and statistics.

In the individualist view, “disease prevention is a process of personal risk assessment, lifestyle adjustment and individual choice.” More specifically, risk assessment is an individual choice for each parent for each child, which evaluates benefits of vaccines, and severity of disease (if the parents choose not to vaccinate, and the child does get sick), along with an assessment of vaccine risk informed by family history, views of children as vulnerable and perfect, and maternal instinct or intuition. These risk assessments and vaccine choices are informed by the knowledge gathered from friends and family, advocacy organizations, and natural living publications.

Only they can keep their children safe! They are heroes!!

Parents who choose to delay or refuse vaccination often focus on natural living as a way to prevent illness and keep their children healthy and safe. These practices are time and labor intensive, but mothers view the work as worthy efforts for the benefit of her child. Privileging the vulnerable, perfect and natural state of their child, mothers rely on natural solutions like breastfeeding and good nutrition, a diet of organic and unprocessed foods, and limiting social contact to manage and control risk.

Although anti-vax mothers are viewed, quite appropriately, as anti-science, that is not how they view themselves:

Although anti/alt­vaxxers are often cast as anti­science by the larger pro­vaxx community and within mainstream parenting groups, they do not experience themselves to be anti­science. In fact, many of the conversations we observed, particularly on the anti/alt­vaxx and natural pages, but even within vaccine debates on mainstream parenting pages, mothers who are defending their choice to deviate from the CDC vaccine schedule do so with what they refer to as “evidence based research” and draw from what they believe to be scientific research. In addition to the natural knowledge production raised above, some of the more popular pages from which alt/anti­vaxx mothers draw their sources from include the Living Whole website, the Healthy Home Economist website, the Sears family website, all of which report on vaccine injury, toxicity, and corruption within big pharma. Overwhelmingly, mothers believe themselves to be informed and to be making the best choices for their children, based on evidence­based research and of course, instinct.

Ultimately:

Natural intensive mothering, a distrust of systematized institutions, and the prominence of individualist choice come together as a reclaiming of the lifeworld space of the family from the system: its unnaturalness, its subjugation of traditional knowledge, its corruption, its judgments, and its privileging of the collective over the individual.

Anti-vax mothers imagine themselves as superheroes!