Homebirth has a #MeToo problem.

Homebirth advocate Rixa Freeze has proudly announced her scientific paper published in conjunction with convicted sexual predator Stuart Fischbein, MD.

The paper is Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]How can homebirth advocates, who claim to support women against the patriarchal medical establishment, continue to embrace a sexual predator?[/pullquote]

Freeze, an English professor with no medical training, is an unassisted birth advocate who nearly killed her third child at unassisted birth in 2011.

In keeping with the narcissism of the unassisted birth movement, Freeze recorded her labor and birth in excruciating detail and then offered publicly it for the world to admire. She inadvertently produced the ideal teaching video for demonstrating how and why babies die in increased numbers at homebirth.

The video includes the immediate aftermath of the birth when baby Inga became profoundly blue and lost all muscle tone due to lack of oxygen. Ultimately Rixa was forced to provide mouth to mouth resuscitation and fortunately, the baby responded. But the baby could have been born already compromised by lack of oxygen during labor. In that case, she would have required a lot more help. She might have needed real and prolonged positive pressure ventilation, she might have needed CPR, she might have needed intubation. Had she been born requiring any of those things (and none of them were available) she likely would have died.

Apparently there’s no problem if you nearly kill your baby during homebirth. That’s half the fun!

But, in my view, there is a big problem if with you work with a convicted sexual predator. Sexual exploitation is probably the most egregious violation of professional conduct that any obstetrician-gynecologist can commit. Dr. Stuart Fischbein is the infamous “Bedside Man.”

According to the Ventura County Star:

His patient, identified in Medical Board records as S.K., was 14 years younger than he and earning her doctorate degree in psychology. She came to Fischbein’s office in Century City with her fiancee. They wanted to have a baby.

… He performed surgery … to remove a mass in her uterus and called her “sweet pea” in the recovery room. He sat at her bedside for long intimate talks, testifying in a hearing he viewed her as not just a patient, but as a woman…

She said he advised her not to have sex for four to six weeks after surgery. Fischbein said in court he didn’t remember the discussion.

Five days after she was released from the hospital and eight days after surgery, he called and asked to visit her at her home in Los Angeles. They had sex then and again two days later at Fischbein’s home…

The California Board of Medicine placed him on probation for 7 years and mandated a chaperone when he examined patients. Unfortunately it didn’t end there.

Early in the probationary period Dr. Fischbein petitioned the Board for termination of probation. They were appalled to learn what he had been doing since his conviction:

In the Fall of 2007, after Petitioner was placed on probation by the Board, he began working with a screenwriter friend on a … a script entitled “Bedside Man.” … The cover of the script states it is “based on a true story,” and credits “Story by Stuart Fischbein.” A promotional trailer was later made, in which Petitioner was also involved and credited… Although fictional names are used in the story, the script and trailer are obviously based on Petitioner’s version of events. [They] tend to minimize Petitioner’s culpability, make him look more like a victim and his victim less of one, and depict Petitioner as being persecuted for his views on some aspects of medicine.

In an effort to promote “Bedside Man” for financial investment to make a full length movie, the trailer was made accessible over the internet. One hospital where Petitioner was affiliated found out about it and contacted Petitioner’s psychotherapist… From her letter detailing the events, it appears that [she] was readily able to see the impropriety of the project while Petitioner had not…

The Board did not terminate the probation, noting:

He has openly chaffed at the requirement that he have a third party chaperone during interactions with female patients. It is clear that once off probation, the chaperone requirement would quickly disappear from his practice as the lessons learned from these events fade and the inconvenience grows…

More alarming was Petitioner’s participation in the movie script and trailer. This activity shows that Petitioner still harbors bad feelings about what happened to him, suggesting that he does not fully believe he engaged in misconduct… Such a state of mind does not bode well for the proposition of removing Petitioner completely from the Board’s probationary oversight. In all, these events demonstrate sufficient concern over the course of Petitioner’s rehabilitation as to indicate that continuing probation with all terms should continue in order to protect the public…

Rixa Freeze has been a staunch supporter of Fischbein all along. In the wake of the Board refusing to revoke his probation, he was threatened with legal action to remove his hospital privileges. Freeze wrote in a post entitled Another Dr. Wonderful needs your help!:

…[A] wonderful obstetrician, Dr. Stuart Fischbein, is being threatened with disciplinary action by his hospital “for violating hospital policies.” The hospital has already suspended the privileges of the two CNMs he works with, and now he faces a possible loss of his livelihood…

Dr. Fischbein is a vocal supporter of midwifery and home birth. His collaborative midwife practice had a primary c-section rate last year of only 5% … and an overall rate of 12% … compared to his colleagues’ 29%…

So what can you do to help? …

Contribute to Dr. Fischbein’s Legal Aid Fund.

I have a question for Rixa Freeze and other homebirth advocates who continue to support and collaborate with Dr. Fischbein:

How can homebirth advocates, who claim to support women against the patriarchal medical establishment, continue to embrace a sexual predator?

I cannot possible imagine a moral justification for ignoring sexual predation but perhaps they can.

Unassisted brake repair. Supportive comments only. No scaremongering.

Sounds stupid, right?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]As a baby struggled, suffered and died, her mother was receiving encouragement to avoid medical assistance.[/pullquote]

What conclusions could we draw about an internet forum with that description?

• The people who created the forum have no interest is hearing anything other than what they already believe.
• The people who created and use the forum understand that the evidence against their choice is very persuasive, so they won’t allow anyone to present it.
• The people who created and use the forum know that their choice is very dangerous and that the truth about it is scary.
• The people who use the forum have doubts about their decision, so they are anxious for “support.”
• The people who use the forum want to promote their choice and therefore have to suppress the truth about the dangers of their choice.
• The people who created and use the forum lack the most basic knowledge about brakes and have convinced themselves that nothing can go wrong if they do it themselves.

Simply put, the people who created and use the forum know that their choice is dangerous and unsupported by evidence, but are looking for those who will cheer them on as they blithely risk their lives and those of anyone who drives with them.

How about an Internet forum for women who choose unassisted childbirth?

Yesterday I wrote about the response of freebirth advocates to a report of baby who was stillborn — dead for days before her birth — because her mother was committed to unassisted childbirth despite multiple risks factors and multiple signs of serious infection and fetal distress. As the baby struggled, suffered and died, the mother was receiving support from an unassisted birth Facebook group encouraging her to avoid medical assistance.

Birth attendant Sarah Tuck defended both the mother and the group.

Perhaps she wanted to get support and not be burned at the stake for choosing autonomous birth. We need safe groups for birth support …

Here’s my question: are women entitled to safe spaces for encouraging each other to risk their babies lives?

You might argue that since a woman has a right to control her own body prior to birth and has no legal obligation to consider the impact on the fetus, there is nothing wrong with constructing a safe space to support her.

How about when we are talking about medical neglect of babies after birth?

Should there be safe spaces for mothers to encourage each other in refusing vaccination and refusing medical care for the inevitable cases of pertussis?

Shayla Cherry was looking for praise when she posted about her toddler’s near death from whooping cough.

One week in and my son’s cough was only getting worse. We were up all night as he began coughing every hour, on the hour. He developed a sharp, desperate inhale; a characteristic whoop every mother hopes to never hear. I began researching pertussis with a sinking heart. Little did I know, we were in for a long and exhausting winter.

The next month was spent indoors as whooping cough tore through our home. Our days were filled with movies, cuddled together in our cozy haze. Sometimes when the coughing woke him at night, he was so exhausted that he’d fall back to sleep without nursing…

On our bed propped on an incline, we slept in fifty-minute bursts. We welcomed play at 2am in the dim hallway light when a coughing fit left him wide awake.

Is she entitled to a safe space to receive support for nearly killing her own child?

How about parents who “treat” their autistic children with bleach?

Why do they do it? Because a quack declared that autism is caused by parasites and that ingesting bleach and bleach enemas can kill those parasites. The following was posted in a Facebook group that had thousands of members dedicated to treating autism with bleach.

Hi everyone I NEED HELP!

My daughter is 7 years old been on cd [chlorine dioxide: bleach] for 4.5 months and began her third pp [parasite protocol] this month. A week ago I began double dosing because she hits her head and gets irritated when her little sister speaks loudly, which causes her to want to head butt her.

I did 38 drops a couple of days ago and she seemed fine and my husband, forgetting, gave her 36 drops on the first day of pp. So yesterday I did 38 drops and she kept going to bathroom and refused to eat. I was a little concerned when she didn’t want to finish her lunch and kept and eye on her.

When dinner time came, I have her mebendazole [anti-parasite medication] she started gagging so I gave her some almond milk and had her sit on the couch. After 5 minutes I gave her her late bite of dinner and not even a minute passed when she threw everything up …

This is the worst kind of medical child abuse imaginable and sadly her mother was abusing her not because she doesn’t care about her but because she does. Is she entitled to a safe space to receive support for her torture of her child?

There are no easy answers to these questions. Free speech is a critical right and we do not want to interfere with that right.

On the other hand, there is no right to subject your child to medical abuse and neglect or to hide evidence of it. There is no right to maintain ignorance. There is no right to be sheltered from criticism. Safe spaces like unassisted birth groups, anti-vax groups and autism “treatment” groups are designed to allow parents to hide medical abuse and neglect, receive support for it, maintain their ignorance and continue torturing their children.

How should we deal with them?

The internet is buzzing with the latest story of a woman who let her baby die at a freebirth.

Freebirth is the bizarre practice of giving birth without a medical professional of any kind because “nature.” Women who choose freebirth seem to have no knowledge of childbirth; if they did, they’d know that the day of birth is the deadliest day in the entire 18 years of childhood. They have no knowledge of history; if they did, they’d know that birth attendants exist is every time, place and culture because childbirth is dangerous and attendants improve outcomes.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Having a right to do something does not make it the right thing to do.[/pullquote]

As is typical for freebirth, the mother was ignoring multiple risk factors that placed her baby at even higher risk:

• The mother was 42 weeks.
• She labored for five days.
• She was leaking meconium.
• The amniotic fluid had a foul smell.
• She only sought medical help after she no longer felt the baby moving.

Her labor started on October 1.

So the surges keep coming every day, but still no baby. Just making me more and more tired and my body ache everywhere. Nothing I could do would ease the pain but I tried so hard to stay positive.

My water broke the evening of the 4th and was discolored. Since I was 42 weeks I thought it was normal. But as the days went by it got more foul smelling and turned a sick poop color which was constantly leaking and the baby stopped moving on the 6th.

I woke on the 7th with so much pain and pouring meconium that Chris and I agreed it was time to transfer.

Not surprisingly, the baby was dead.

Or as the mother said:

Journey Moon M. was born as a sleeping angel on Oct. 7th at 8 lb. 13 oz.

That sounds much nicer than the truth that the baby died a preventable death from Group B strep infection (as per the autopsy) days before birth and macerated for days —both before and after birth — in foul smelling, infected meconium.

Whose fault it is that Journey Moon is dead? The blame lies with her mother and the members of the freebirth Facebook group that encouraged her every step of the way. As is typical with the irresponsible, narcissistic outlook of women who choose freebirth, the mother insists this was a random event.

I posted an article recounting the baby’s death on my Facebook page and another freebirth aficionado, Sarah Tuck, swooped in the berate me and my readers.

You women are so fucked up. Stop being stupid assholes and actually care about your sisters in this world.

Who is Sarah?

I have two masters degrees and tons of experience in trauma counseling, midwifery, education, etc.

Not exactly.

Sarah is an assistant/apprentice midwife with Harvest Moon Women’s Health. She has a background in photography and education… Sarah has a Bachelors Degree in Photography/Art and a Masters Degree in Childhood Education. She began coursework the The Ancient Art Midwifery Institute in 2015. She is trained with several midwifery schools doing hands on workshops. She has worked with 6 different midwives during her past 12 months as an apprentice. She has been to mostly home-births and also birth center and hospital births as well. She is CPR and NRP certified. She is currently working with D.H. and is getting close to reaching 30 births! She is also trained as an herbalist, doula, nutrition counselor, preconception counselor, Thai Massage, and has been working in women’s health for 4 years. And she takes amazing birth photos!

Sarah is a birth photographer who actually thinks that attending courses with the clowns at Ancient Art Midwifery Institute has made her knowledgeable about childbirth.

Sarah the birth photographer is horrified that anyone would dare hold this freebirth mother to account. She fails to understand that just because a woman has a right to have a freebirth doesn’t mean that it is the right thing to do or that other women should support it.

How can that be?

Free speech offers a good analogy. The first amendment guarantees the right to free speech, but that doesn’t mean that anyone is required to agree with or support the substance of that speech.

Consider the 1977 case of the American Nazi party vs. Skokie, Illinois. Nazis wanted to wave swastikas and march through Skokie, a town settled by large numbers of Holocaust survivors:

[T]he necessary implication of the Supreme Court’s 1977 NSPA decision … is that a group’s request to engage in a parade or demonstration involving public display of the Nazi swastika is a symbolic form of free speech that is at least presumptively entitled to First Amendment protections. In other words, the Court’s decision implies that First Amendment protection would not be denied to use of the swastika …

But just because the First Amendment protects the right to wave a swastika flag in front of the citizens of Skokie does not mean that doing so is worthy of agreement or support. That Nazis who sought to march were evil people who didn’t care whom they hurt. They are not entitled to or worthy of respect.

Similarly a woman’s right to control her own body means that authorities cannot prevent her from having a freebirth, but that doesn’t make it a moral choice or worthy of support. It remains an ignorant, narcissistic, immoral choice that should be condemned.

In keeping with the narcissism of freebirth, Sarah insists:

Ha! You’re just jealous because we had fucking amazing births and feel empowered enough to take you all down! Home birth is on the rise and we are not getting any more silent. Nor will we go away.

Hilarious! Sarah imagines we envy her when in truth we are disgusted by her. Home birth is on the rise? Well, yes, if you mean that it has gone from a fringe practice that leads to preventable infants deaths to a slightly more popular fringe practice that leads to preventable infant deaths.

To the extent that I feel anything at all for women who choose freebirth and their babies, I feel pity. Imagine having a mother so selfish and narcissistic that she is literally willing to risk your life for her own “empowerment.” No child deserves that.

Women who let their own babies die at freebirth have a right to do so, but that doesn’t change the fact they are responsible for their immoral choice and its deadly outcome.

I’ve written many times about the obstetric lie that will not die: the unsubstantiated “optimal” C-section rate of less than 15%.

• It was fabricated from whole cloth in 1985, apparently to suit the prejudices of the man behind it.
• There was never any evidence to support it.
• It was officially debunked in 2015 when it was shown that a minimal rate of 19% was necessary for safety.

Nonetheless, a series on C-sections just published in The Lancet uses the thoroughly discredited “optimal” rate of 10-15% as a benchmark. This despite the fact that the World Health Organization, which fabricated the “optimal” rate has acknowledged there was NEVER any evidence to support it.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]They feel in their gut the optimal C-section rate must be 10-15%, damn the absence of evidence and the existence of research that shows they are wrong.[/pullquote]

Buried deep in its 2009 handbook Monitoring Emergency Obstetric Care, you can find this:

Although the WHO has recommended since 1985 that the rate not exceed 10-15 per cent, there is no empirical evidence for an optimum percentage … the optimum rate is unknown …

Indeed Marsden Wagner, the WHO official who appears to be behind the fabricated rate acknowledged in a paper he wrote in 2007:

…[T]his paper represents the first attempt to provide a global and regional comparative analysis of national rates of caesarean delivery and their ecological correlation with other indicators of reproductive health…

In that paper Wagner found that nearly every country with a C-section rate less than 15% had appalling levels of maternal and neonatal mortality.

A 2015 paper Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality found that a minimum C-section rate of 19% is required for low levels of maternal and neonatal mortality.

National cesarean delivery rates of up to approximately 19 per 100 live births were associated with lower maternal or neonatal mortality among WHO member states. Previously recommended national target rates for cesarean deliveries may be too low.

Ironically, the press release accompanying The Lancet series was followed by this correction:

The level of C-section use required for medical purposes provided in the press release below is no longer a recommendation from the World Health Organisation (WHO). In the 2015 Statement on Caesarean Section Rates, WHO stated that “Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate”.

The 10-15% C-section use is still used as a practical indicator of underuse and overuse.

This line has now been corrected from:
It is estimated by the World Health Organisation that 10-15% of births medically require a C-section due to complications, suggesting that average C-section use should lie between these levels.

To:
It is estimated that 10-15% of births medically require a C-section due to complications, suggesting that average C-section use should lie between these levels.

Why is The Lancet still using the never empirically supported, withdrawn and now discredited “optimal” rate of 10-15%?

They have replaced scientific truth with truthiness.

Steven Colbert coined the term “truthiness.” According to Wikipedia:

Truthiness is the belief or assertion that a particular statement is true based on the intuition or perceptions of some individual or individuals, without regard to evidence, logic, intellectual examination, or facts. Truthiness can range from ignorant assertions of falsehoods to deliberate duplicity or propaganda intended to sway opinions.

In an out of character interview with the Onion’s A.V Club Colbert explained:

Truthiness is ‘What I say is right, and [nothing] anyone else says could possibly be true.’ It’s not only that I “feel” it to be true, but that “I” feel it to be true. There’s not only an emotional quality, but there’s a selfish quality.

For reasons that I do not fathom, the authors of The Lancet series, as well as many others working on the issue of C-sections, feel in their gut that the optimal C-section rate must be 10-15%, damn the absence of evidence and the existence of research that shows they are wrong.

The insistence on using a discredited optimal C-section rate puts the entire Lancet series in question. According to the press release:

Globally, the number of babies born through caesarean section (C-section) almost doubled between 2000 and 2015 – from 12% to 21% of all births – according to a Series of three papers published in The Lancet and launched at the International Federation of Gynecology and Obstetrics (FIGO) World Congress in Brazil. While the life-saving surgery is still unavailable for many women and children in low-income countries and regions, the procedure is overused in many middle- and high-income settings.

The authors insist that this is a crisis, but if they were to use the actual scientific evidence that a minimal C-section rate of 19% is necessary for low rates of maternal and neonatal mortality there wouldn’t be a crisis at all. The current C-section rate would be only slightly higher than the minimally acceptable rate, a reason for satisfaction not alarm.

By replacing truth with truthiness, the authors have ignored science in favor of personal belief. That is an unpardonable sin for anyone claiming to be a scientist.

Kudos to the Journal of Human Lactation for publishing a paper that challenges a central lactivist assumption.

The paper is Breast Is Best . . . Except When It’s Not by Lynne M. McIntyre, MSW, Adrienne Marks Griffen, MPP, Karlynn BrintzenhofeSzoc, PhD. Each woman suffered postpartum depression:

We come to the intersection of PMADs [perinatal mood and anxiety disorders] and breastfeeding not only as perinatal mental health professionals but also as mothers who suffered from postpartum depression and anxiety and who breastfed our five children for a combined total of more than 6 years. Our individual experiences with PMADs affected us so profoundly that we each changed our careers. We each have served as coordinators with Postpartum Support International for more than a decade, providing direct support to women experiencing PMADs and researching, educating, and advocating about these illnesses…

The authors learned from both personal and professional experience how breastfeeding can be harmful to women’s mental health. In other words, for many women breastfeeding is not best and the pressure to breastfeed is injurious.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactivists have aggressively shamed women into breastfeeding. It’s inevitable that such cruel, cynical efforts would harm women’s mental health.[/pullquote]

We estimate that far more than half of the new mothers who seek our assistance struggle with breastfeeding emotionally, physically, or both. Some want to breastfeed but are not able; others do not want to breastfeed but feel enormous pressure to do so. Some wean earlier than planned; others breastfeed, pump, and/or bottle feed around the clock for many months. The vast majority indicate that their breastfeeding experience and their mental health are inextricably intertwined.

The authors demonstrate how the message that “breast is best” is harmful for many women.

1. Sense of failure

Lactation failure includes (a) failure of the breasts to produce adequate milk, (b) failure to thrive in the infant, and (c) failure of the mother to achieve her preset goal for duration of lactation. This sense of failure can be compounded if a new mother finds that breastfeeding, which she believed would be easy, natural, and enjoyable, instead is difficult, painful, or unpleasant.

The sense of failure is exacerbated by lactation professionals’ unwillingness to counsel women about the difficulties and risks of breastfeeding as well as the benefits.

2. Fear of medication

Too many parents and providers believe that women suffering PMADS face an either/or decision: either treat their PMADs with psychotropic medication or continue breastfeeding. Fortunately, this is not true for most postpartum mental health conditions. Although there is no completely risk-free approach, there are many medications to treat anxiety and depression that are widely considered safe for lactating women and their infants. Professionals who work with lactating women should understand the risks of not treating PMADs as well as the risk of the specific medication being considered and should be able to discuss the risks and benefits with their patients so that no woman feels that she must choose between breastfeeding her infant and her own mental health.

In a curious omission, the authors fail to address the issue of women with pre-existing mental health disorders for which they already take medication and took medication before pregnancy. Many of these women are at heightened risk for the development of PMADs unless they continue their medication. They, too, must be counseled about appropriate medication choices and should never be encouraged to avoid medication in order to breastfeed.

3. Sleep deprivation

Sleep interruption prevents deep restorative REM sleep, which can exacerbate symptoms of anxiety or depression. Severe sleep deprivation and poor sleep quality are widely considered risk factors for PMADs. As a result, reproductive psychiatrists often encourage their patients to try to obtain 5 to 6 hr of uninterrupted sleep before progressing to treatment with medication.

In other words, sleep is preventive treatment for PMADs, yet lactation professionals counsel women to adopt practices that further exacerbate sleep deprivation. These include allowing newborns to nurse for comfort, discouraging pacifiers and the utterly barbaric practice of recommending that women who have low supply should nurse, pump and feed expressed breastmilk. Such practices drive up the physical and psychic costs of breastfeeding substantially.

4. Shame

For mothers suffering PMADs or breastfeeding challenges, the postpartum period in general and breastfeeding in particular can be very challenging. Acknowledging these struggles is often accompanied by shame and stigma, which can lead a new mother to deny and/or hide her symptoms from the friends, family, and providers who could help. Sleep deprivation, anxiety, and depression distort thinking; in this context, a new mother may equate her lack of enjoyment of motherhood or breastfeeding with the belief that she is a “bad” mother. Perinatal professionals who honestly and nonjudgmentally assist women in making decisions concerning breastfeeding and PMADs can greatly help to reduce shame and stigma.

Sadly, this is a feature of contemporary lactivism, not a bug. For the past 20+ years lactation professionals have aggressively attempted to shame women into breastfeeding by exaggerating its benefits and refusing to acknowledge its risks. It was inevitable that such cruel and cynical efforts would harm women’s mental health.

The real problem is that contemporary lactivist philosophy considers mothers’ needs irrelevant. It’s hardly surprising that the same people who ignore women’s pain, ignore their frustration, ignore their perceptions of inadequate breastmilk, ignore their right control their own bodies and ignore their need to care for other children and/or to work have no trouble ignoring the impact of breastfeeding on women’s mental health.

The authors offer several suggestions to minimize the harmful effects of breastfeeding promotion on women’s mental health. The most important is the acknowledgement that there’s nothing wrong with formula.

The current recommendation from virtually all parties concerned with maternal-child health, from the WHO to the American Academy of Pediatrics, is that infants should be provided only human milk for the first 6 months of life. Although this recommendation for exclusive breastfeeding is derived from solid research and is widely considered most beneficial for the infant, it does not necessarily take into account the well-being and mental health of the mother. Unfortunately, we have seen that adhering to this recommendation has sometimes exacerbated the depression or anxiety of mothers with whom we have worked. If we bear in mind that recommendations are guidelines, not rules, we can better support mothers as they incorporate these recommendations into their own, unique situations.

They conclude:

[W]e have worked with hundreds of women for whom breastfeeding was not working, was not possible, or simply was not desired. We have held them and counseled them as they not only grieved but also judged themselves failures as mothers. These women have taught us that it may be time for a new motto: “Breast is best . . . except when it’s not.”

I would go farther. In truth, breast is NOT best. It is only slightly better at the population level but that tells us NOTHING about whether it is good for an individual mother-baby dyad. It’s time to stop pretending otherwise.

Over the years I’ve made a variety of arguments about contemporary midwifery and lactivist philosophies:

1. They subvert science by exaggerating benefits of favored treatment options (unmedicated vaginal birth and breastfeeding).

2. They threaten safety by ignoring risks of favored treatment options.

3. They falsely declare favored treatments save money but neglect to include costs.

4. They are multi billion dollar businesses, not selfless provision of care.

5. They are anti-feminist because they judge women by the function of their reproductive organs.

But even if we were to ignore all these faults, we would still be left with the biggest drawback of them all; contemporary midwifery and lactivist philosophy are unethical.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It is unethical to use population level outcomes as justification to ignore patient preferences.[/pullquote]

Why?

As the authors of Shared decision is the only outcome that matters when it comes to evaluating evidence-based practice explain:

[E]valuations of the impact of evidence-based practice (EBP) are invariably focused on improving population-level health outcomes (overall incidence of heart attacks or hospitalisations) rather than at the individual patient level.

We believe this focus is inappropriate and fundamentally flawed for the following reasons.

Population-level health outcomes rarely if ever take into account patient values and preferences and therefore by definition fly directly in the face of the fundamental goals and definition of EBP. Ignoring patient values and preferences or at least not placing them at the forefront of decision making legitimises the argument that the presence of effects at population levels is sufficient justification for recommending treatments even though the absolute magnitude of these changes clearly may not be important to all individual patients.

The authors are not writing about efforts to promote unmedicated vaginal birth or breastfeeding, but they could be. The problem is:

[A] fundamental misunderstanding many have about EBP: that the rationale and justification for EBP relies on being able to demonstrate that EBP somehow should lead to better clinical outcomes. This common misunderstanding pervades the current scientific discourse around EBP and impedes how, as a society, we should practice medicine. EBP is about taking care of individuals and is not about the insensitive use of population-based evidence. As soon as the question moves to one of clinical outcomes, this individual-to-population frame-shift occurs and clinicians often consider scientific probability at aggregate levels. Looking at outcomes for individuals is entirely different from thinking about evidence from large groups in trials and in cohorts.

In other words, EVEN IF unmedicated vaginal birth or breastfeeding are shown to have population level benefits, that does NOT justify pressuring patients to make those choices. That’s because scientific evidence is a tool akin to a measuring tape to be used to evaluate various treatment options, not a cudgel to be used to beat patients into conformity.

So, for example, we can counsel a patient about the population level outcomes of various treatments for a his metastatic cancer, but it would be unethical to pressure him to choose the option that has the best population benefit if it does not comport with his preferences.

So, for example we can counsel a pregnant woman whose fetus has a severe brain malformation about the dismal population level outcomes for babies like hers, but it would be unethical to pressure her to terminate the pregnancy if that does not comport with her personal beliefs.

So, for example, we can counsel a pregnant woman about increased systemic risks of a C-sections, but it is unethical to refuse maternal request C-sections.

So, for example, we can counsel a new mother that breastfeeding has population level benefits for babies, but it is unethical to pressure her to breastfeed because that is “best.”

The authors include a graphic that offers even more examples of what evidence based practice is NOT.

It’s NOT about saving money so it wouldn’t matter if vaginal births and breastfeeding save money (although they don’t).
It’s NOT only about the results of clinical trials and systematic reviews so no amount of scientific evidence on the “risks” of epidurals or formula feeding should be used to prevent a woman from opting for either one.
It’s NOT about achieving a specific outcome; it’s about achieving the outcome the patient prefers.

It is about using the best available evidence in a hierarchical way to answer clinical questions. But the answer to the clinical question is NOT the ethical determinant of the treatment, the patient’s decision is the determinant.

The authors conclude:

Evaluating evidence based practice decisions — N always=1

As healthcare professionals, we accept the need to explain to patients there is evidence of effective treatments at population levels. However, the decision whether to adopt most treatments at an individual level is a decision that is unique, context-based and derived by careful deliberation about trade-offs. This careful deliberation defines EBP, and in the vast majority of circumstances, the only outcome of relevance for EBP is to measure whether a shared decision was made.

The bottom line is that no amount of population based evidence justifies ignoring the needs and desires of the individual patient.

Imagine if an anti-abortion protester wrote:

If you believed some you would think that for women choosing to terminate a pregnancy continuing it instead is bad for women’s mental health.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Both anti-abortion activists and breastfeeding advocates ignore the critical importance of the ability to choose unfettered by the “support” of those who want them to make different choices.[/perfectpullquote]

But pregnancy does not damage maternal mental health. In fact, pregnancy can do marvelous things for women’s well-being. Alongside reducing risk of reproductive cancers like ovarian cancer and breast cancer, it can help women feel empowered, confident, and heal childhood trauma, too. Childbirth hormones are even thought to help reduce the impact of stress and sleep deprivation upon the body. It’s no wonder that numerous studies have found that compared to women women who suffer miscarriages, those who continue a pregnancy have a lower risk of depression.

That’s why terminating a pregnancy is always the wrong choice. The problem is not pregnancy itself. Instead it is the lack of support and investment in helping women choose life. Most women who choose termination do so because they antipicate lack of support, hardship, or difficulty making ends meet. Those of us who give abortion counseling at our clinics offer women the support they need to continue pregnancy, not end it.

You might respond with several critical facts that the protester left out:

1. No one ever said the problem is pregnancy itself; the issue is that unwanted pregnancy can be devastating for women’s mental health and every other aspect of her wellbeing.

2. Yes, pregnancy has health benefits, but pregnancy itself is life threatening. Terminating a pregnancy is actually healthier for women than continuing it.

3. The fact that women are devastated by miscarriage of a wanted pregnancy tells us nothing about the impact of continuing an unwanted pregnancy.

4. The conviction that every woman who choose to terminate a pregnancy would continue it if she just got more support reflects deliberate obtuseness. It emphasizes short term drawbacks when the real issue may be very different.

Now consider that the claims above were not made by an anti-abortion protester. They are a nearly word for word adaptation of claims made by a professional lactivist. They come from a recent piece by Prof. Amy Brown, Breastfeeding is good for mothers’ mental health – but those who struggle need support.

Brown, too, displays deliberate obtuseness. She is certain — every bit as certain as anti-abortion protesters are certain — that every women who formula feeds would breastfeed if she just got more support. She, too, emphasizes short term issues when the real issues for women who choose formula may be very different.

Brown also deliberately misrepresents the situation in the exact same way as any abortion opponent.

1. No one has ever said the problem with aggressive breastfeeding promotion is breastfeeding. The problem is pressuring women who don’t want to breastfeed, find breastfeeding painful and frustrating or discover they cannot produce enough milk to fully nourish a baby.

2. Yes, breastfeeding has benefits, but it also has significant risks — risks that are routinely elided or denied in the same way that anti-choice advocates ignore the risks of pregnancy.

3. The fact that women are devastated by being unable to breastfeed if they had intended to do so tell us nothing about the mental health impact of not breastfeeding on women who don’t want to do so. Furthermore, it tells us nothing about the impact of pressure to breastfeed on the mental health of women who who prefer to formula feed.

4. Most importantly, the same people who exclaim over women devastated by failure to breastfeed fail to consider that THEY are responsible for that sense of failure. To my knowledge, there was very little if any angst about formula feeding UNTIL lactivists started pressure women to breastfeed. It seems particularly cruel for lactivists to berate women who don’t breastfeed as substandard mothers depriving babies of incredible health benefits and then offer sympathy for their feelings of “failure.”

Both anti-choice activists and breastfeeding advocates ignore the critical importance of the ability to choose unfettered by the “support” of those who want them to make different choices.

Anti-abortion activists insist that waiting periods for abortion, unwanted ultrasounds and mandated medical “counseling” are being offered to help women make informed decisions. Lactation professionals insist that locking up infant formula, forcing women to sign consent forms for formula and mandated medical “counseling” about the benefits of breastfeeding are being offered to help women make informed decisions. Both groups are lying to themselves and others. Such practices are forced on women to pressure them to make pre-approved decision.

Her baby, Her body, HER choice! Why is that so hard for activists of all kinds to understand?

Most contemporary breastfeeding research is deeply suspect because researchers start with the conclusions — breastfeeding must be best! — and work backward to support it.

As one after another of claimed benefits of breastfeeding have melted away when studies are corrected for maternal education and socio-economic status, breastfeeding researchers have become ever more creative in fabricating fanciful new “benefits.” The latest fad is to claim epigenetic benefits of breastfeeding.

There are 5 reasons to ignore epigenetic claims about breastfeeding, but before we review them some background is in order.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]As benefits have melted away when studies are corrected for socio-economic status, breastfeeding researchers have become ever more creative in fabricating fanciful new “benefits.”[/perfectpullquote]

What is epigenetics?

Epigenetics refers to mechanisms of gene regulation that determine the state of a cell and that are heritable through cell divisions but that do not involve changes in DNA sequence… It is often more specifically used to refer to chemical modifications (such as methylation or acetylation) of DNA or of the histone proteins associated with it in chromatin. These epigenetic marks can affect gene expression and can be stably inherited from one cell to another (i.e., through mitotic cell division).

The impact of epigenetics was discovered long before anyone understood the mechanisms of genetics, let alone epigenetics. Researchers noted that famine in Northern Sweden in the mid 1800’s seem to affect the health of their grandchildren decades later. In a subsequent observation, children who had survived famine during WW II seem to suffer more cardiovascular disease later in life.

[Lars Olav] Bygren had a long running interest in the lifelong effects of nutrition, and particularly of starvation…

Bygren realized that Överkalix, where he was born, would make for a perfect study. Not only were there centuries worth of birth, death, and agricultural records, but the people living in the remote terrain of Överkalix had remained genetically isolated for centuries.

What did he find?

Among the 1905 birth cohort, those who were grandsons of Överkalix boys who had experienced a “feast” season when they were just pre-puberty—a time when sperm cells are maturing—died on average six years earlier than the grandsons of Överkalix boys who had been exposed to a famine season during the same pre-puberty window, and often of diabetes… It appeared that Överkalix grandfathers were somehow passing down brief but important childhood experiences to their grandsons…

Modifications in response to famine — not of DNA itself but of chemical tags on DNA that control expression of genes — could be inherited.

Breastfeeding researchers promptly seized on that fact to make new claims:

The notion of epigenetic effects of breastfeeding seems to be widely held, and a Google search (January 23, 2017) using the search terms “epigenetics breastfeeding” resulted in approximately 111,000 hits…

At the moment there is no evidence that breastfeeding has any causal epigenetic benefits and considerable reason to ignore such claims.

1. Even with established epigenetic effects, the impact is paradoxical:

For instance, why is it that the amount of food available to a paternal grandfather seems to affect the mortality risk ratio of his grandsons but not his granddaughters? Or why is it that the food supply of a paternal grandmother is only associated with the mortality risk ratio of her granddaughters? Pressing even further, why would a reduced risk of cardiovascular death be linked to a mother’s good food supply but also to a father’s poor food supply? Right now, we just don’t know the answers to these and similarly complex epigenetic questions.

2. To date, most epigenetic associations involve environment, not exposure to specific substances.

An environment of famine or plenty has been shown to have epigenetic effects, but single foods have not. It is entirely possible that any epigenetic impact of breastfeeding has more to do with the amount of breastmilk (or formula) available than with the substance itself.

3. Although we don’t know for sure, it is assumed that epigenetic effects are adaptive.

The epigenetic impact of famine is different than the epigenetic impact of plenty because famine requires different adaptations to maximize survival than plenty requires. Famine is a recurring theme in human history; it makes sense that humans would have developed adaptive strategies to improve survival.

In contrast, whether or not a specific food (e.g. wheat, honey, deer meat) is available does not seem to impact survival so there is no reason to “adapt” to it. Unless and until we can show that specific foods matter, there is no reason to believe one — including breastmilk — has any epigenetic “benefit” over any other.

Moreover, until recently there has been no safe substitute for breastfeeding. Therefore it is difficult to imagine why breastmilk would have induced epigenetic adapatations.

4. Socio-economic status almost certainly has an epigenetic impact.

Differences in socio-economic status creates differences in environment. Children growing up in poverty have a completely different set of biological challenges than those growing up with wealth. Impoverished children may experience a longterm evironment of food scarcity, contaminated water, inadequate heating, and limited or no access to treatment for common health problems. They may develop epigenetic adaptations to meet those challenges.

Socio-economic status is already a confounding factor in breastfeeding research. In industrialized countries breastfeeding is closely tied to higher economic status. Almost all the health “benefits” of breastfeeding are benefits of wealth. Similarly, any epigenetic “benefits” of breastfeeding may actually be epigenetic benefits of wealth.

5. The prenatal environment may lead to epigenetic changes that modulate infant response to the postnatal environment.

Newborn babies aren’t new. They’ve been growing and developing for 9 months before birth in an environment determined in part by their mother’s environmental exposures. It is highly plausible that starvation, pollution, environmental exposures such as those to tobacco and alcohol and maternal illness could have epigenetic effects on the developing fetus. These pre-existing epigenetic changes may modify the impact of breastfeeding on babies. At the moment these cannot be teased apart from epigenetic effects of poverty or theoretical epigenetic effects of breastfeeding.

The claim that breastfeeding has epigenetic benefits — in the absence of evidence of causation of any kind — is a sign of desperation among breastfeeding researchers. As previously claimed benefits evaporate when exposed to greater scientific scrutiny, breastfeeding researchers have had to plumb deeper for new “benefits.” But the bottom line remains the same:

Breastmilk is milk, not magic, no matter how vehemently breastfeeding researchers insist otherwise.

UK midwives are tricking women out of epidurals:

A forum post that asked mothers “anyone else tricked out of epidural?” attracted 1,000 replies in under two weeks.

For example:

Vanessa Murphy still remembers the pain. “I was so traumatized,” the 39-year-old compliance officer says. “I remember repeatedly saying I wanted to die.”

When Murphy entered the maternity ward to give birth to her daughter in February 2016, she was told that she couldn’t have an epidural until she was in active labor. When she entered labor, she requested one repeatedly. She never received it.

“Every time I spoke about the birth, even over a year later, I cried,” she tells Broadly. “It affected my ability to feel able to have another child and also felt guilty that I felt traumatized even though the birth had resulted in delivering a healthy baby.”

Why didn’t she get the epidural that she requested?

Months later, she questioned her care at a meeting with the Head of Midwifery at her ward. She was told that the staff had made a clinical decision not to give her the pain relief she requested. They thought she was going to deliver before it took effect.

Making a decision about a women’s pain relief without taking her wishes into account is misogyny pure and simple and misogyny has been the foundation of the philosophy of natural childbirth from its inception in the UK to its expansion in the US.

Few people are aware that the philosophy of natural childbirth was created explicitly as a response to the political and economic emancipation of women; even fewer understand that Ina May Gaskin, a heroine of the natural childbirth movement, reified that misogyny in her practice, writing and lectures.

I’ve written extensively about the origins of the philosophy of natural childbirth in the eugenics of obstetrician Grantly Dick-Read, its founder:

The mother is the factory, and by education and care she can be made more efficient in the art of motherhood.

Grantly Dick-Read’s theory of natural childbirth grew out of his fear that “inferior” people were having more children than their “betters” portending “race suicide” of the white middle and upper classes. Dick-Read believed that women’s emancipation led them away from the natural profession of motherhood toward totally unsuitable activities. Since their fear of pain in childbirth might also be discouraging them, so they must be taught that the pain was due to their false cultural beliefs. In this way, women could be educated to have more children.

According to Read:

Woman fails when she ceases to desire the children for which she was primarily made. Her true emancipation lies in freedom to fulfil her biological purposes …

The comparisons between “overcivilized” white women and “primitive” women who gave birth easily was not merely the product of racism, but reflected the anxiety that men felt about women’s emancipation. This anxiety was expressed in medicine generally, and in obstetrics and gynecology particularly, by the fabrication of claims about the “disease” of hysteria and the degeneration of women’s natural capabilities in fertility and childbirth compared to her “savage” peers. Simply put, the result of women insisting on increased education, enlarged roles outside the home and greater political participation was that their ovaries shriveled, they suddenly began to experience painful childbirth and they developed the brand new disease of “hysteria”, located in the uterus itself.

Pain in childbirth served a very important function in this racist and sexist discourse: it was the punishment that befell women who became too educated, too independent and left the home. The idea that “primitive” women had painless childbirth was fabricated to contrast with the painful childbirth of “overcivilized” women.

Grantly Dick-Read was issuing a warning to women of a certain social class: if you step beyond the roles prescribed for women, you will be punished with painful labor. And if you have had painful labor, you should understand it as a punishment for ignoring your “natural” duty to stay home and procreate.

As Burke and Seltz note in Mothers’ Nature: Feminisms, Environmentalism, and Childbirth in the 1970s:

When Americans began trying to make birth more natural in the 1940s, they invoked familiar associations among women’s bodies, a nature found inside and outside those bodies, and motherhood as both chosen role and biological destiny. The doctors and white middle-class women who first used the term “natural birth” equated nature with normal physiology and with the domestic ideal …

Natural childbirth became an important part of the counter culture in the 1970’s:

In 1976, the midwife Ina Gaskin published the first edition of Spiritual Midwifery…. Gaskin has taught at Yale’s school of nursing and continues to practice midwifery at The Farm, the Tennessee intentional community that she and her spouse Stephen Gaskin founded in 1971.

That’s one way to put it. In truth the Farm was a cult and Stephen Gaskin was the leader of the cult. Women were relegated to “women’s work” including midwifery.

For Gaskin and many other commune dwellers, natural birth made women the physical equals of men, but their strength fed family togetherness, not women’s independence.

In other words, Gaskin’s philosophy of spiritual midwifery recapitulated the subservient nature of Gaskin to her husband.

If a woman was not attentive enough to her husband during labor, Gaskin sometimes suggested that she pay him more attention. If husbands were not sufficiently “connected,” Gaskin might recommend that they leave and gather themselves emotionally. On The Farm a good mother was part of a good couple and contributed to a good family…

Gaskin’s contemporaries noticed that her view of childbirth re-inscribed traditional misogynistic beliefs.

Nora Ephron remarked that:

the tyranny of the obstetrician is eliminated — and the tyranny of the method is substituted …

In both cases, women are pressured to fulfill someone else’s idea of what their needs and desires, not their own.

She elaborated:

What I’m complaining about … [is]the fact that something that ought to liberate women seems — however subtly — to be oppressive… It never crossed my mind that I would live through the late 60’s and early 70’s in America only to discover that in the end what was expected of me was a brave, albeit vigorous squat in the fields like the heroine in ‘The Good Earth.’

The radical feminist Shulamith Firestone was even more emphatic in her rejection natural childbirth. She embraced technology including artificial reproduction:

At least until the taboo is lifted,” she argued, “until the decision not to have children or to have them by artificial means is as legitimate as traditional child-bearing, women are as good as forced into their female roles.

The result is that natural childbirth does not liberate and empower women; it oppresses them.

While some women redefined the term “nature” to fit their expectations of birth, others put intense pressure on themselves to match a particular vision of nature. Sometimes, women who accepted pain medication felt profound internal conflicts over their choice, specifically because they felt they had strayed from what they defined as natural…

The decision of thousands of UK midwives to deny women epidurals that they requested is just the latest example of the misogyny that has pervaded natural childbirth advocacy since its inception. To paraphrase Ephron: the misogynist tyranny of the obstetrician has been replaced by the misogynist tyranny of natural childbirth advocates, and women continue to suffer as a result.