During the Vietnam War, a military officer remarked about the village of Ben Tre:

“It became necessary to destroy the town to save it.

The quote came to epitomize the brutality and absurdity of the war itself, a war based on killing people in order to “save” them.

I was reminded of that quote by Dr. Melissa Bartick’s irresponsible and hypocritical opinion piece in Maternal Child Nutrition, Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution. Bartick promotes the deadly practice of co-sleeping in order to support breastfeeding. Apparently she is blind to the absurdity of letting babies die in order to save them.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Dr. Melissa Bartick promotes the deadly practice of co-sleeping.[/pullquote]

When I first saw the evidence about the deadly risks of co-sleeping, I was not persuaded. I had co-slept with my own babies and it was difficult to contemplate that I might have put them at risk. Over the years, however the evidence has become overwhelming and I have come to understand just how deadly co-sleeping can be.

According to the American Academy of Pediatrics:

…[B]ed-sharing is associated with an increased risk of SIDS; a recent meta-analysis of 11 studies investigating the association of bed-sharing and SIDS showed a summary OR of 2.88 (95% CI: 1.99–4.18) with bed-sharing. Furthermore, bed-sharing in an adult bed not designed for infant safety, especially when associated with other risk factors, exposes the infant to additional risks for unintentional injury and death, such as suffocation, asphyxia, entrapment, falls, and strangulation. Infants younger than 4 months194 and those born preterm and/or with low birth weight are at the highest risk, possibly because immature motor skills and muscle strength make it difficult to escape potential threats. In recent years, the concern among public health officials about bed-sharing has increased, because there have been increased reports of SUIDs occurring in high-risk sleep environments, particularly bed-sharing and/or sleeping on a couch or armchair.

It is incontrovertible that bed sharing nearly triples the risk of infant death from SIDS. But apparently for Bartick that pales into insignificance compared to the benefits of promoting breastfeeding. She seems to believe that it makes sense to let babies die in order to save them.

Her “argument” is an inane exposition of the naturalistic fallacy, the fallacy that because something was done in nature, it always and forevermore ought to be continued.

Recommendations enforcing separate sleep are based on 20th century Euro‐American social norms for solitary infant sleep and scheduled feedings via bottles of cow’s milk‐based formula, in contrast to breastsleeping, an evolutionary adaptation facilitating the survival of mammalian infants for millennia. Interventions that aim to prevent bedsharing, such as the cardboard baby box, fail to consider the implications of evolutionary biology or of ethnocentrism in sleep guidance…

As I explained yesterday, only someone who doesn’t understand evolution would offer such a foolish justification for risking babies’ deaths.

Bartick appears to believe that evolution produces perfection and therefore, any deviation from the past is a deviation from perfection. But evolution does not produce perfection; it is based on survival of the fittest. By definition, in the state of nature, some will live, many will die. Why would we want to copy that?

From an evolutionary perspective, the most successful animals are those who can adapt to new environments, not those who are slavishly devoted to recapitulating the behavior of their ancestors. It doesn’t matter what happened in the past, only how well the animal can cope with present conditions.

Even if it were the case that women and babies co-slept in the past, they did so on bare ground in the cold. Humans haven’t slept on the bare ground in the cold since fire was mastered. The way we sleep has changed over time and now we sleep in ways that are harmful to babies: on soft surfaces, with soft bedding, some of us having smoked tobacco, or ingested alcohol or pharmaceuticals.

The parents who will be most successful evolutionarily are those who let their offspring sleep in a separate bed, on a firm surface, with no bedding or soft toys.

But Bartick isn’t interested in what’s good for babies, she’s interested in what is good for breastfeeding.

She writes

Recognizing breastsleeping as the evolutionary and cross‐cultural norm entails re‐evaluating our research and policy priorities, such as providing greater structural support for families, supporting breastfeeding and safe co‐sleeping, investigating ways to safely minimize separation for formula‐fed infants, and mitigating the potential harms of mother–infant separation when breastsleeping is disrupted…

Pro-tip for Dr. Bartick: a dead baby can’t breastfeed.

Promoting co-sleeping is the equivalent of destroying babies in order to save them.

It’s also extraordinarily hypocritical.

Bartick and other professional lactivists have implied that women who choose formula feeding because breastfeeding causes pain, frustration and exhaustion are “selfish” women more concerned for their own convenience than for their baby’s wellbeing.

In promoting bed sharing, Bartick notes:

Research shows that bedsharing breastfeeding mothers nurse their infants 5.75 times during the night (often without realizing it), compared to 2.5 times a night for moms and babies who do not share a bed.

There is nothing inherent in sleeping separately that prevents a mother from breastfeeding exclusively. Bed sharing just makes breastfeeding more convenient. But according to lactivist logic, if convenience is not an acceptable reason for using formula instead of breastfeeding, it couldn’t possibly be an acceptable reason for refusing to get out of bed to nurse an infant as often as he or she wants.

Lactation professionals have no trouble telling women to set an alarm and pump multiple times during the night in order to boost supply, why don’t they tell breastfeeding mothers to set an alarm and get up and breastfeed 5.75 times a night to maintain breastfeeding while avoiding infant death? Can it be that breastfeeding mothers are simply too lazy and selfish?

Bartick writes:

Moving forward, our frame of reference in determining risk and public policy to manage risk must be normative human physiology …

Wrong! Our frame of reference in determining risk ought to be scientific evidence, not what our ancestors did in the past.

Anything else amounts to letting babies die in order to save them.

Yesterday a young woman thought she would call me out on Twitter. It didn’t go quite as she had planned; she ended up looking very foolish.

In the rant that followed, McGann who apparently prides herself on her knowledge of evolution revealed that she doesn’t understand evolution. A lot of natural parenting advocates have the same problem.

The key mistake is embodied in this tweet:

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Evolution teaches us that those who adapt and change are most successful, and those who insist on copying their ancestors will end up extinct.[/perfectpullquote]

#Breastfeeding is the result of a 7 million-year, randomized, double-blind, large-scale, longitudinal study called natural selection. This is not Appeal to Nature, but a sign post pointing right at where we should be directing the research.

So many errors in so few words:

• evolution is not an RCT since evolution acts on all possible variables at once;
• evolution does not create perfection;
• evolution leads to survival of the fittest; by definition many will die.

But the key mistake, one beloved of natural parenting advocates, is the idea that we evolved for a particular environment and we should do all we can to recapitulate that environment. That’s the exact OPPOSITE of what evolutionary theory tells us. It goes back to one of Charles Darwin’s most important discoveries about the finches in the Galápagos Islands.

A few million years ago, one species of finch migrated to the rocky Galapagos from the mainland of Central or South America. From this one migrant species would come many — at least 13 species of finch evolving from the single ancestor.

This process in which one species gives rise to multiple species that exploit different niches is called adaptive radiation. The ecological niches exert the selection pressures that push the populations in various directions. On various islands, finch species have become adapted for different diets: seeds, insects, flowers, the blood of seabirds, and leaves.

The ancestral finch was a ground-dwelling, seed-eating finch. After the burst of speciation in the Galapagos, a total of 14 species would exist: three species of ground-dwelling seed-eaters; three others living on cactuses and eating seeds; one living in trees and eating seeds; and 7 species of tree-dwelling insect-eaters.

The finches can teach us critical lessons about evolution.

1. Fitness is not static.

As conditions changes, fitness changes. And conditions always change, whether it is climate, pressure from other species, local events like volcanic eruptions, etc. There is no such thing as an animal that is “perfectly fit” because there is no such thing as a static environment.

Had Darwin’s finches behaved like natural parenting advocates, they would have whined that they were adapted for ground dwelling and seed eating and therefore, they should continue living on the ground and eating seeds regardless in the dramatic change in conditions.

2. Fitness is tied to the environment.

When the ancestral finch migrated to the Galápagos Islands, its fitness was determined by the environment there. In most cases, the ancestral finch wasn’t particularly fit at all, despite its fitness on the mainland. Evolution caused the finches to evolve new traits, specific to the specific environment.

How successful do you think the seed eating finches were on islands that had very few seeds of the type they had been evolved to eat? Not very. That’s why they evolved characteristics like changes in beaks to allow them to eat different seeds and, in some cases, switched from seeds to insects.

How successful do you think the ground dwelling finches were on islands that had ground dwelling predators? Not very. That’s why they evolved to live in both cactuses and trees.

3. The most successful animals are those who can adapt, not those who remain unchanged. It doesn’t matter what happened in the past, only how well the animal can cope with present conditions.

If we anthropomorphize the finches, we can see just what is wrong with the philosophy of natural parenting.

Suppose the ancestral finches who arrived in the Galapagos had surveyed the situation on each island and announced:

“We were evolved to live on the ground and eat seeds. Therefore, we will continue living on the ground and eating seeds and pretend we are still on the mainland.

“Any finches who sample the different local seeds are benighted fools and inferior to us. They aren’t adapated to eat those seeds so they will certainly not thrive but will become obese, get cancer and auto-immune diseases and die out quickly. We will be the ones who survive.

“Any finches who choose to live in trees or, heaven forefend on ugly cactuses, are also fools and inferior to us. We were evolved to live on the ground and so we will continue to live on the ground, no matter the existence of local predators. We simply need to “trust” that the ground is safe and that will make it safe.

“Nature has rendered us perfectly evolved and all we have to do is live like we have always lived.”

They would have been wrong in every conclusion. The finches destined to be most successful were those who abandoned the way they had evolved and sought out new food sources and new places to live.

It’s not hard to see the parallels with natural parenting.

Lactivists are equivalent to finches who insisted on eating seeds because they always ate seeds. In their view, breastfeeding must be superior because humans have always breastfed. But we no longer live in the state of nature and haven’t for more than 10,000 years. The parents who will be most successful evolutionarily are those who teach their offspring to take advantage of new foods like formula when beneficial. In nature, many babies died due to insufficient breastmilk; those babies can now survive on formula. They are fitter for the current environment.

Parents who advocate co-sleeping are equivalent to finches who insisted on living on the ground even though there were new predators on the ground. In their view, co-sleeping must be superior because humans co-slept in the past. But even if that were the case, they co-slept on the bare ground in the cold. Humans haven’t slept on the bare ground in the cold since fire was mastered. Just like the finches found ground predators on new islands, we now sleep in ways that are harmful to babies: on soft surfaces, with soft bedding, some of us having smoked tobacco, or ingested alcohol or pharmaceuticals. The parents who will be most successful evolutionarily are those who let their offspring sleep in a separate bed, on a firm surface, with no bedding or soft toys.

We have no trouble understanding that finches who insisted on living like their ancestors despite a new enviroment became evolutionary failures. Similarly, natural childbirth advocates who insist that giving birth like our foremothers is “best” are destined to be evolutionary failures as their children die at homebirths or because they refused routine prenatal testing and interventions.

The ultimate irony is that evolution teaches us that those who adapt and change are most successful, and those who insist on copying their ancestors will end up extinct.

It happened again! I wrote about something and activists rush to demonstrate exactly what I was talking about.

Yesterday I mentioned the rabid hatred that lactivists direct toward the Fed Is Best Foundation. With three little words, “Fed Is Best,” Christie del Castillo Hegyi, MD and Jody Segrave Daly RN, IBCLC have blown apart lactivist frames with a more accurate frame, one that doesn’t marginalize and silence women who can’t or don’t breastfeed.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The Becoming Breastfeeding Friendly group at the YSPH are apparently unfamiliar with the breastfeeding literature.[/pullquote]

In other words, Jody and Christie (both of whom breastfed) are whistle blowers. And like most people who blow the whistle on any industry, they have been subjected to industry sponsored abuse

The Yale School of Public Health has joined the pile on. Surprisingly for a group of people who run a program called Becoming Breastfeeding Friendly, they don’t seem to know very much about breastfeeding.

Let’s state the situation is simple terms. Breastfeeding, which has been promoted as the optimal nutrition for all babies, is actually resulting in the iatrogenic brain damage and preventable deaths of babies. The breastfeeding industry, instead of moving to prevent these injuries and deaths, is reacting with fury.

As I’ve written in the past, it reminds me of the response of Merck when the news became public that Vioxx, a blockbuster pain reliever, was leading to preventable deaths: deny, defy and decry. In this case, they are attacking Kavin Senapathy,who wrote in Forbes about the World Health Organizations declaration that breastfeeding related brain damage and deaths are “not a priority.” Through her, they are going after the Fed Is Best Foundation.

The Yale authors write:

In Kavin Senapathy’s opinion article, the suggestion that the 2017 revised WHO Baby Friendly Hospital Initiative (BFHI) guidelines place newborns at risk of starvation or severe complications is not supported by the evidence of decades of research in the area of breastfeeding and human milk. We are deeply concerned because it could lead to serious misunderstandings for expecting parents and the general population.

The tactic of denial is typically the first step employed by Big Pharma when one of its drugs comes under attack. The drug company claims that the scientific research did not show that the drug was harmful. It’s as if we are supposed to pretend the deaths didn’t happen because they weren’t anticipated by the research.

In the case of Vioxx, the scientific research DID show that Vioxx led to unanticipated cardiac deaths; that research was suppressed. In the case of breastfeeding, the research DOES show that breastfeeding leads to unantipicated brain injuries and deaths; the members of the Yale Breastfeeding Friendly group are either unaware of that research or choose to ignore it.

They write:

We agree with the notion that we must acknowledge the existence of the problem of insufficient breastmilk. However, the article fails to consider that this problem, which is manifested as an inadequate supply of breastmilk needed to properly feed one’s baby (Neifert, 2001; Wilson-Clay & Hoover, 2013), is most often characterized by a phenomenon known as perceived insufficient milk (Safon et al., 2017; Segura-Millán et al., 1994). Also known as insufficient milk syndrome, in the vast majority of cases it is the result of widespread lack of access to both prenatal and postnatal optimal breastfeeding support and lactation management rather than primary biological reasons (Gussler & Briesemeister, 1980; Tully & Dewey, 1985).

Horrifyingly, the group is gaslighting women whose babies have been brain injured and died as a result of insufficient breastmilk. Lactivists have attempted to frame the problem of insufficient breastmilk as a figment of mothers’ imagination.

Sure, insufficient breastmilk is not a problem according to lactivist theory, but then Vioxx was not a problem according to Big Pharma theory, either. But just as in the case of Vioxx, in practice, insufficient breastmilk DOES injure and kill babies and the perception of insufficient breastmilk is NOT a figment of womens’ imagination.

Let’s look at the real evidence, not the theory.

Insufficient breastmilk is common, not rare.

In 2010, the Academy of Breastfeeding Medicine acknowledged:

It is important to recognize that not all breastfed infants will receive optimal milk intake during the first few days of life; as many as 10–18% of exclusively breastfed U.S. newborns lose more than 10% of birth weight.

There is a biomarker for insufficient breastmilk.

From a 2001 paper:

High levels of sodium in breast milk are closely associated with lactation failure. One study showed that those who failed lactation had higher initial breast milk sodium concentrations, and the longer they stayed elevated, the lower the success rate.

Insufficient breastmilk is NOT a figment of women’s imagination.

This was confirmed in a 2017 paper that also showed that women who felt they had insufficient breastmilk were more likely to have the biomarker present.

…[E]levated day 7 breast milk Na:K occurred in 42% of mothers with a day 7 milk supply concern, compared with 21% of mothers without a day 7 milk supply concern (unadjusted relative risk, 2.0; P = .008) (Table II). The unadjusted odds of elevated Na:K were 2.7 greater (95% CI, 1.3-5.9) with maternal report of milk supply concern (refer- ence = no concern, P = .01) and further increased after ad- justment for maternal ethnicity (3.4; 95% CI, 1.5-7.9; P = .003).

The potential brain threatening and life threatening consequences include kernicterus, hypernatremic dehydration and severe hypoglycemia.

Kernicterus, thought to have nearly disappeared, is making a comeback.

Dr. Lawrence Gartner revealed to other lactation professionals in a 2013 lecture, 90% of cases of kernicterus (jaundice induced brain damage) are caused by insufficient breastmilk.

The Academy of Breastfeeding Medicine reported in a 2017 paper:

In the U.S. Kernicterus Registry, a database of 125 cases of kernicterus in infants discharged as healthy newborns, 98% of these infants were fully or partially breastfed …

Neonatal hypernatremic dehydration is more common than SIDS.

From 2016 paper :

In a retrospective study in the United Kingdom, the frequency of breastfeeding-associated neonatal hypernatremia was found to be greater than all-causes combined of hypernatremia among late preterm and term newborns.81 In the mentioned report, the incidence of sodium level ≥ 160 was 71 per 100 000 breastfed infants (1 in 1400).

The consequences include death and potentially devastating neurologic injury as this 2017 study explains:

In our study 7 out of 65 patients died as a result of complications of hypernatremia. There was a significant correlation between severity of hypernatremia and mortality (p = 0.001). All who died had serum sodium concentration >160 mmol/L…

All infants in the control group were developmentally normal at ages 6 and 12 months, but in the case group 25% and 21% had developmental delay at 6 and 12 months, respectively. At 18 months the incidence of developmental delay was 3% for the control group and 19% for case group, and at 24 months 12% of case infants had developmental delay versus none for the control group…

Hypoglycemia also injures and kills babies.

A 2017 paper reports that the UK has paid out $250 million dollars for brain injuries due to hypoglycemia, nearly all cases the result of insufficient breastmilk.

I’m going to charitably assume that the Yale breastfeeding group is simply unaware of the depth and breadth of the literature on insufficient breastmilk and the brain injuries and deaths it causes. The alternative would be that the group is actively concealing the latest research findings in order to keep women in the dark about the deadly risks of breastfeeding.

They close their piece with a paragraph that would be laughable if the issue weren’t so serious:

Overall, an extensive review of the literature was warranted but not employed in writing this opinion piece. We need to provide mothers with high-quality, unbiased and uncompromised breastfeeding support both during and after pregnancy…

The people who failed to do an adequate literature review were the folks from Yale.

The bottom line, though, is this: If Yale School of Public Health group doesn’t have command of the breastfeeding literature, especially the latest scientific papers, they have no business criticizing those who do. Otherwise that criticism comes across the same way as such efforts on the part of Big Pharma do: attempts to silence whistle blowers in order to keep market share.

A political pollster once said, “If you frame the problem, you own it.”

He meant that if you could convince others to refer to the problem in your terms, you are almost assured of having control over an issue. For example, consider the way people frame abortion. Those who think women should be allowed to control their own reproductive organs refer to themselves as “pro-choice.” Abortion opponents recognized early on that “anti-choice” would not make a good moniker, so they refer to themselves as “pro-life,” despite the fact that restricting abortion leads to maternal deaths. Language can be used to signal views and to attempt to persuade others to those views.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breast Is Best frames women who can’t or don’t breastfeed as inferior, abnormal, lazy liars; Fed Is Best frames them as loving mothers.[/pullquote]

Lactivists have attempted to use language in this way and not merely to signal their views or to persuade others to those views. They also use language to marginalize any woman who does not share their views. That is both anti-feminist and unethical.

Consider:

Lactivists frame breastfeeding as “best” despite the fact that for many babies and mothers it isn’t best at all. “Breast is Best” is arguably the most powerful frame that lactivists have employed. While it is theoretically meant to refer to the relative merits of breastmilk and infant formula, its secondary purpose is to marginalize women who can’t or don’t breastfeed. What kind of mother gives her infant “second best”? Only a bad mother. In three simple words, lactivists have labeled women who use formula as bad mothers.

Never mind that breastmilk is NOT best for all babies. Never mind that many women cannot make enough breastmilk to fully nourish an infant. Lactivists have language to erase those facts.

For many years, lactivists have framed insufficient breastmilk as rare. That’s not what the scientific evidence shows, but lactivists have told that falsehood so many times that many of them now believe it themselves. It’s a falsehood with a specific purpose; it is meant to characterize women who report low supply as liars. It’s hard to think of a more effective way to silence women who can’t breastfeed then to imply that they are liars who are only trying to justify the fact that they are bad mothers.

Lactivists frame all breastfeeding problems as due to “lack of support.” This serves two purposes. One: to marginalize and silence women who don’t want to use their breasts to nourish their babies. It is basically an accusation of false consciousness. The second purpose is economic. If successful breastfeeding is simply a matter of support, the reasoning goes, we should just hire more breastfeeding support people.

Lactivists have framed promoting breastfeeding as “normalizing” breastfeeding. The implication is not subtle: women who can’t or don’t breastfeed are abnormal.

Social media have become an important components in an all out effort to marginalize and silence women who can’t or don’t breastfeed. They intensively mediate breastfeeding discourse, allowing only that discourse that supports the preferred frames.

Lactivists frame breastfeeding supportive websites and Facebook pages as islands within a culture that is not supportive of breastfeeding. That’s a convenient fiction; fiction because it’s hard to imagine a society that has ever been more supportive of breastfeeding than this one and convenient because it allows for the literal silencing of women who can’t or don’t want to breastfeed by deleting their posts and comments. There’s no better way to promote the frame that breastfeeding problems are rare than by literally erasing women’s attempts to share those problems.

Lactivist allow the mention of breastfeeding difficulties if they can frame them as surmountable. Women are allowed to present their problems on social media if they are asking for the guidance of the group, blame themselves, acknowledge that with enough effort they can fix the problem, and continue breastfeeding regardless of whether their babies are dehydrated, jaundiced and starving to death.

Lactivists frame pediatricians and any other providers who are not explicitly commmitted to the agreed upon frames as “uneducated.” This serves a variety of purposes. It frames lactation professionals as having knowledge that others do not have (even though many pediatricians and obstetricians are women who have breastfed). It allows breastfeeding professionals to advise women to ignore pediatricians when they dare to value the health of the baby above the act of breastfeeding and it allows lactivists to silence women who fear for their baby’s health as gullible for believing other providers.

Lactivists frame breastfeeding as both natural (implying ease and an absence of problems) and hypermedicalized: requiring books, classes, coaches, mechanical breast pumps, herbs and pharmaceutical galactologues to increase supply, elimination diets, surgery on babies tongues to correct latch and a raft of expensive consumer goods like breastfeeding pillows, clothing, salves and foods. This double framing means that though breastfeeding is touted as natural, women who aren’t successful at breastfeeding can be portrayed as unwilling to do the hard work and spend the money to succeed.

Lactivists frames are anti-feminist. The frames are deliberately intended to deprive women of choice in infant feeding. The frames are deliberately intended to marginalize women who can’t or don’t breastfeed as inferior, abnormal, lazy and victims of false consciousness.

Lactivists frames are unethical because they put the brains and lives of infants at risk. A substantial proportion of mothers (as many as 1 in 7) cannnot produce enough milk to fully nourish an infant; those babies brains and lives are at risk from hypoglycemia, dehydration, and severe jaundice. The frame that insufficient breastmilk is “rare” is nothing more than a bald-faced lie. The frame that formula supplementation is harmful ignores the science that show judicious formula supplementation increases the odds of extended breastfeeding. The frame that pacifiers interfere with breastfeeding ignores the science that shows that they save infant lives. When lactivists lie, babies die.

The intensive lactivist efforts at framing explain the rabid hatred directed at the Fed Is Best Foundation. With three little words, “Fed Is Best,” Christie del Castillo Hegyi, MD and Jody Segrave Daly RN, IBCLC have blown apart lactivst frames with a more accurate frame, one that doesn’t marginalize and silence women who can’t or don’t breastfeed.

Instead of framing these mothers as inferior, abnormal, lazy liars, Fed Is Best frames them as loving.

Instead of framing them as women who are avoiding their most important responsibility, they frame them as bucking a tide of hostility and abuse to protect their babies above all.

Most importantly, instead of protecting breastfeeding, they protect babies from brain damage and death.

That’s why lactivists save a special frame just for them; Christie and Jody (both of whom breastfed) are framed as anti-breastfeeding when they are really pro babies and mothers.

I wrote Birth plans: worse than useless over 5 years ago but it remains one of the most read, most commented upon pieces on this blog.

A new paper in the “journal” Birth (owned by Lamaze International), Birth plans—Impact on mode of delivery, obstetrical interventions, and birth experience satisfaction: A prospective cohort study by Afshar et al. shows that birth plans are still worse than useless, not merely failures on their own terms, but actually making women feel less satisfied than they would have without birth plans.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Having a birth plan is as effective as having a weather plan for the day of birth.[/pullquote]

Three hundred women were recruited: 143 (48%) had a birth plan. There was no significant difference in the risk of cesarean delivery for women with a birth plan compared with those without a birth plan (21% vs 16%, adjusted odds ratio [adjOR] 1.11 [95% confidence interval (CI) 0.61-2.04]). Women with a birth plan were 28% less likely to receive oxytocin (P < .01), 29% less likely to undergo artificial rupture of membranes (P < .01), and 31% less likely to have an epidural (P < .01). There was no difference in the length of labor (P = .12). Women with a birth plan were less satisfied (P < .01) and felt less in control (P < .01) of their birth experience than those without a birth plan.

It’s really not surprising when you consider that birth plans, like most of natural childbirth philosophy, was conjured from thin air, with no investigation as to whether they worked or if the assumptions behind them were accurate.

… Birth plans were originally introduced in the 1970s as a communication tool. In the 1980s, after criticism of an overly “medicalized” view of childbirth, the World Health Organization went on to classify birth plans in the top category of recommended practices for making pregnancy safer…

But the truth is that birth plans were created by birth paraprofessionals as a way empower themselves and stick a proverbial finger in the eye of obstetricians. Birth plans engender hostility from the staff, are usually filled with outdated and irrelevant preferences, and create unrealistic expectations among expectant mothers. And they don’t work.

This is not news.

Joanne Motino Bailey, CNM et al. in Childbirth Education and Birth Plans, noted:

There are no randomized controlled trials that analyze birth plans …

Brown and Lumley stated that “women who made use of a birth plan were more likely to be satisfied with pain relief, but did not differ from women not completing a birth plan in terms of overall rating of intrapartum care, or involvement in decision making about their care.” Whitford and Hillan found that most women who completed a birth plan found it useful and stated they would write another birth plan in a future pregnancy, although most did not believe it made any difference in the amount of control they felt during labor and many did not think enough attention had been paid to what they had written.

Birth plans do not improve outcomes. As Pennell et al, pointed out in Anesthesia and Analgesia–Related Preferences and Outcomes of Women Who Have Birth Plans:

…Analgesic preferences were reported to be the most important birth plan request. Greater than 50% of women requested to avoid epidural analgesia; however, 65% of women received epidural analgesia. On follow-up, greater than 90% of women who received epidural analgesia reported being pleased…

But most importantly, birth plans increase disappointment. In Is the Childbirth Experience Improved by a Birth Plan?, Lundgren et al. were surprised to find:

… A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving women’s experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery…

Yet in 2017, people keep studying them, apparently hoping that this time the results will be different. Afshar et al. found weren’t:

The World Health Organization, American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics have suggested that birth plans may be a vehicle for women to communicate what their preferences for childbirth are and that birth plans may be associated with improved patient safety and satisfaction. Despite these recommendations, there is little data with respect to the role of the birth plan in facilitating patient-provider communication or the efficacy of the birth plan with respect to mode of delivery.

And:

…[D]espite receiving care consistent with their birth plan, women with birth plans described not feeling in control and were less satisfied with their birth experience than those women without birth plans.

The authors evince surprise about this results, but they shouldn’t. Having a birth plan is like having a weather plan for the day of birth. It is utterly ineffective and very likely to end in disappointment.

Birth plans reflect the fundamental fraud at the heart of natural childbirth advocacy, the insistence that a woman’s experience of childbirth is all in her head and that by planning and directing her thoughts appropriately she can have whatever experience she wants. That makes as much sense as claiming that the weather is all in one’s head and that by planning and directing your thoughts you can have whatever weather you desire.

Birth plans don’t merely fail in their stated aim, there’s no way that they could ever succeed. The key to a safe, satisfying birth experience is flexibility based on the understand that no one can control childbirth. Anything else will inevitably lead to increasing disappointment, not preventing it.

Yes, you read that right, the aggressive promotion of breastfeeding by the Baby Friendly Hospital Initiative has led to an epidemic of newborn brain damage.

No less an authority than Lawrence Gartner, MD, member of the BFHI Board of Directors has admitted that 90% of kernicterus cases are attributable to breastfeeding! Sadly, Dr. Gartner acknowledged it only to other breastfeeding professionals. Parents and pediatricians have been left in the dark.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breastfeeding is responsible for over 90% of jaundice-induced brain damage.[/pullquote]

What is kernicterus?

Children’s Mercy Hospital Kansas City has an easy to understand explanation for lay people:

Kernicterus is a form of brain damage caused by excessive jaundice. The substance which causes jaundice, bilirubin, is so high that it can move out of the blood into brain tissue.

Kernicterus is disastrous for babies:

When babies begin to be affected by excessive jaundice, when they begin to have brain damage, they become excessively lethargic. They are too sleepy, and they are difficult to arouse – either they don’t wake up from sleep easily like a normal baby, or they don’t wake up fully, or they can’t be kept awake. They may have a high-pitched cry, and decreased muscle tone, becoming hypotonic or floppy with episodes of increased muscle tone (hypertonic) and arching of the head and back backwards. As the damage continues they may arch their heads back into a very contorted position known as opisthotonus or retrocollis, they may develop fever, and they may even develop seizures (convulsions).

The jaundice is caused by breastfeeding induced starvation.

It is important to understand that In 2017, kernicterus is an iatrogenic injury. It is astoundingly easy to prevent; judicious formula supplementation will prevent it 100% of the time.

The slides for Dr. Gartner’s lecture to the California Breastfeeding Summit are chilling.

The most common cause of kernicterus used to be Rh incompatibility; and Rh- negative mother attacked the red blood cells of her Rh+ baby. With the advent of Rhogam, Rh incompatibility is only rarely a problem.

As Dr. Gartner pointed out:

We thought kernicterus had disappeared! It has not! … What types of infants are still having kernicterus? All kinds of children – but one type has emerged recently as predominant.

Breastfed infants: 90% of all cases of kernicterus especially with weight loss in excess of 10%.

The Academy of Breastfeeding Medicine suggests that the contribution of breastfeeding starvation may be even higher.

In the U.S. Kernicterus Registry, a database of 125 cases of kernicterus in infants discharged as healthy newborns, 98% of these infants were fully or partially breastfed …

As a result of aggressive breastfeeding promotion, those babies were allowed to starve.

Strong evidence suggests that increased serum bilirubin in the first few days is highly correlated with suboptimal enteral in- take; serum bilirubin concentrations are highly associated with greater weight loss in breastfed infants.

In summary:

• We are experiencing an epidemic of jaundice-induced brain damage (kernicterus) in newborns.
• Between 90-98% of cases are the direct results of aggressive breastfeeding promotion.
• In every one of those cases, brain damage could have been completely prevented by formula supplementation.
• Kernicterus is almost non-existent in formula fed babies.

If we care about babies, the solution is obvious: Every baby should be aggressively monitored for adequate breastmilk intake and when there is any doubt about intake, babies should be supplemented with formula.

We could EASILY prevent 100% of breastfeeding starvation jaundice by feeding at risk babies (those who have lost 10% of body weight or have elevated bilirubin above physiological levels). It would cost very little, only a tiny fraction of the cost of hospital readmissions, phototherapy, and subsequent treatment for brain injuries.

But lactation professionals are apparently more interested in promoting breastfeeding than in promoting infant health.

It may be necessary to supplement with infant formula if neither own mothers’ milk nor donor human milk is available. The impact of introducing formula to an exclusively breastfed infant must be considered.

Wait, what? We are talking about preventing brain damage!

From the paper Impact of bilirubin-induced neurologic dysfunction on neurodevelopmental outcomes:

Kernicterus most usually is characterized by choreoathetoid cerebral palsy (CP), impaired upward gaze, and sensorineural hearing loss, whereas cognition is relatively spared…

But levels below that needed to cause kernicterus can also result in brain injuries:

Clinically, BIND [bilirubin induced neurologic dysfunction] may manifest after the neonatal period as developmental delay, cognitive impairment, disordered executive function, and behavioral and psychiatric disorders…

There is no possible impact of formula on breastfeeding that is even remotely worth considering compared to preventing cerebral palsy, hearing loss, cognitive impairment, disordered executive function and other behavioral and psychiatric disorders. The benefits of breastfeeding in industrialized countries are trivial and certainly pale into insignificance besides these risks.

What is going on here?

Sadly, a group of health professionals has become so invested in a process – breastfeeding – that they are willing to destroy baby’s brains in order to protect that process.

Indeed, as Kavin Senapathy reported in Forbes:

When asked [by the Fed Is Best Foundation] whether WHO plans to inform mothers of the risks of brain injury from insufficient breast milk, and that temporary supplementation can prevent complications, Dr. Rollins responded that this recommendation was not identified as a “top priority.”

The bottom line is that we’ve spent the last 30 years aggressively promoting breastfeeding and all we have to show for it is an epidemic of iatrogenic brain damage.

Protecting babies brains is infinitely more important than protecting breastfeeding.

 

As of today, 4300 parents and professionals have signed the petition to implore the WHO to make breastfeeding induced brain injuries a priority. Please join them.

One of the great ironies of the philosophy of attachment parenting is that is contradicts what we know about infant attachment.

The founding studies of Attachment Theory were led by scientists like John Bowlby, Harry Harlow and D.W. Winnicott. Their most critical finding was that human contact was more important than any particular parenting practice. For example, Harry Harlow’s monkey experiments demonstrated beyond doubt that mothers matter more than milk.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breastfeeding doesn’t create the bond between mother and child, comfort does.
[/pullquote]

We produced a perfectly proportioned streamlined body stripped of unnecessary bulges and appendices… The surrogate was made from a block of wood, covered with sponge rubber, and sheathed in tan cotton terry cloth. A light bulb behind her radiated heat. The result was a mother, soft, warm, and tender …

Harlow also constructed wire monkey mother-substitutes.

…[W]e also designed and constructed a second mother surrogate, a surrogate in which we deliberately built less than the maximal capability for contact comfort. This surrogate mother … is made of wire-mesh, a substance entirely adequate to provide postural support and nursing capability, and she is warmed by radiant heat. Her body differs in no essential way from that of the cloth mother surrogate other than in the quality of the contact comfort which she can supply.

The babies had access to both the cloth and wire-mother substitutes:

Harlow varied which substitute could feed the babies:

This is what he found:

The babies greatly preferred the cloth mother even when the wire mother was the only one that could provide food.

He wrote:

These data make it obvious that contact comfort is a variable of overwhelming importance in the development of affectional response, whereas lactation is a variable of negligible importance. With age and opportunity to learn, subjects with the lactating wire mother showed decreasing responsiveness to her and increasing responsiveness to the nonlactating cloth mother …

Interestingly, the baby monkeys fed on formula were much healthier than their breastfed peers:

We had separated more than 60 of these animals from their mothers 6 to 12 hours after birth and suckled them on tiny bottles. The infant mortality was only a small fraction of what would have obtained had we let the monkey mothers raise their infants. Our bottle- fed babies were healthier and heavier than monkey-mother-reared infants … thanks to synthetic diets, vitamins, iron extracts, penicillin, chloromycetin, 5% glucose, and constant, tender, loving care.

What can we learn from Harlow’s monkey experiments, experiments that are at the heart of the core of Attachment Theory?

Mothers matter more than milk.

Babies become attached to whomever offers comfort, not to whomever offers milk. Breastfeeding (or formula feeding) doesn’t create the bond between mother and child, comfort does.

Why do lactivists and attachment parenting advocates ignore this central finding of Attachment Theory? It’s because lactivism isn’t about what’s good for babies; it’s about forcing women to breastfeed. Attachment parenting isn’t about what’s good for babies, either; it’s about forcing women back into the home occupied by only by traditional parenting practices. It’s at heart a religious philosophy, not the product of scientific evidence.

What does this mean for mothers?

It means that your baby needs YOU, not your breastmilk. If you want to breastfeed, go right ahead, but if you don’t want to breastfeed, there’s no evidence that formula feeding has any impact on the mother-infant bond. And if you are having trouble breastfeeding, there is no value in letting your baby go hungry or enduring pain or sacrificing your mental health in an effort to provide the supposed “extra” benefit of breastfeeding. The supposed extra benefit is trivial.

The real benefit of infant feeding comes from the mother, not from the milk.

Civil War General William Tecumseh Sherman famously said, “War is hell.” It’s an accurate description, so it’s surprising that very few people said it before the 19th Century. War is about maiming, gutting, killing other human beings. and potentially being killed oneself. It is horrifying in every possible way, yet that is not how it has traditionally been portrayed. Young men were (and in some places still are) taught that war is about courage and honor, that it is the highest pursuit of “real” men and that success in battle is the ultimate achievement.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The philosophy of natural childbirth bears as much relationship to childbirth as army recruiting posters bear to the reality of war.[/pullquote]

For most women, childbirth is hell, replete with agonizing pain, blood and bodily fluids. Traditionally it has been portrayed as excruciating, life threatening and a punishment administered to women by God. But in the mid 20th Century, natural childbirth advocates decided to romanticize it. They romanticize the pain by minimizing it, attaching spiritual significance to it, or by claiming that it is “good” for mothers and babies. They romanticize the dangers by pretending they don’t exist, and they romanticize the death toll by ignoring it altogether. Natural childbirth advocates go so far as to appropriate the classic exhortations of war mongers. Indeed, they refer to women as “birth warriors.”

What’s the worst thing that a man can be in society that values war? A coward. There is nothing worse than refusing to fight, particularly if it is because of the fear of being killed. Cowards are vilified in societies that value prowess in war and brave men receive medals. Natural childbirth advocates have appropriated the same reasoning, even if they express it slightly differently. What’s the worst thing that a pregnant woman can be in a subculture that romanticizes birth? Someone who does not “trust” birth, but “fears” it, i.e. a coward. Natural childbirth advocates teach women that birth is about courage and honor, that it is the highest pursuit of “real” women and that “success” in birth is the ultimate achievement.

The natural childbirth literature is filled with claims about the pernicious nature of fear in childbirth. It is considered the ultimate put down of doctors, who supposedly have created a “culture of fear” around birth. Fearing pain, and abolishing it with pain relief is derided as the province of weak women who are unwilling to fulfill their true function in life. Being alert for complications is asserted to cause complications. Most importantly, just as men who fear war are shamed with the appellation ‘coward,’ women who do not subscribe to the romantic idealization of birth asserted by NCB advocates are also shamed. They are portrayed not merely as cowardly, which is bad enough, but as bad mothers who care more about themselves than the well being of their babies.

Why did generations of men romanticize war? They did so for a very simple reason, to get other men to follow them into battle. Who would want to go to war if they knew what it was really like. Why do natural childbirth advocates romanticize birth? To get other women to validate them by following them and mirroring their choices.

The most important thing that every women needs to know about the philosophy of natural childbirth is that it bears as much relationship to childbirth as army recruiting posters bear to the reality of war. Both are all about hiding the grim and painful reality because very few people would willingly choose either war or natural childbirth if they knew the truth.

According to Wikipedia, a whistleblower:

is a person who exposes any kind of information or activity that is deemed illegal, unethical, or not correct within an organization … [A]whistleblower can bring allegations to light by contacting a third party outside of an accused organization such as the media, government, law enforcement, or those who are concerned.

What typically happens to whistleblowers?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Like a drug company hiding the risks of its product, the breastfeeding industry is smearing the whistleblower.[/pullquote]

Whistleblowers, however, take the risk of facing stiff reprisal and retaliation from those who are accused or alleged of wrongdoing.

That’s just what has happened to the Fed Is Best Foundation and its creators, Christie del Castillo-Hegyi, MD and Jody Segrave-Daly, RN, IBCLC. The latest example is a piece by lactation consultant Kimberly Seals Allers that is notable for two reasons: it fails to address the serious risks of breastfeeding that the Fed Is Best Foundation has brought to light; and it is a transparent attempt to smear the Foundation.

To understand what the Fed Is Best Foundation has done and the furious response in return, it helps to consider a similar example, the behavior of Merck and the FDA in response to whistleblowing about Vioxx.

Why are they similar?

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. The FDA was aware of those side effects but ignored them.

Breastfeeding is a biological process with small benefits from most 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.

What happened with Vioxx? According to Forbes:

On Nov. 18, [2004] an unassuming safety researcher from the U.S. Food and Drug Administration sat down before a Senate committee and tore his bosses to shreds.

The FDA, he said, had ignored warnings that the pain pill Vioxx was killing people by causing heart attacks and strokes–and he said the agency was incapable of defending the public against another drug disaster…

Without Graham, the Vioxx debacle might have been seen as an isolated event. But because he was willing to step into the spotlight, the withdrawal of Vioxx from the market looks like part of a systemic failure to properly weigh the risks and benefits of drugs…

What has happened with Fed Is Best?

Through personal experience (Dr. Del Castillo-Hegyi’s son suffered a serious brain injury and many of Ms. Segrave-Daly’s patients have been harmed), the founders of Fed Is Best became convinced that the breastfeeding industry was injuring and killing babies by refusing to acknowledge both the high incidence (up to 15% of first time mothers) and serious risks of insufficient breastmilk.

Deaths like that of newborn Landon Johnson (If I Had Given Him Just One Bottle, He Would Still Be Alive) could have been seen as an isolated event, but in part because the Fed Is Best Foundation has been willing to step into the spotlight, a re-examination of the serious risks and side effects of breastfeeding is now underway.

How was FDA whistleblower Graham treated by the FDA? According to an expose by CBS’ Sixty Minutes:

But just a week before the hearing began, a series of anonymous phone calls were made in an attempt to discredit him. Graham’s attorney, Tom Devine, who represents government whistleblowers, says the callers argued it would be a mistake for him to represent Graham.

“They said that he was a demagogue, he was a bully, that he had engaged in questionable scientific tactics,” says Devine. “They said he was a dangerous man and he had to be stopped.”

Devine says he asked for proof, but the callers couldn’t provide it: “And by that point, I’d used the caller ID to trace back who was talking to me, and it turned out they were high-level members of FDA management.”

“These are people – senior managers within the FDA – calling you, pretending to be whistleblowers,” asks Stewart.

In an attempt to silence Dr. Graham, they called him a demagogue, a bully and accused him of engaging in questionable scientific practices.

How is the Fed Is Best Foundation being treated by the breastfeeding industry? Here’s what Seals Allers has written:

… Is Fed is Best more interested in saving lives or stoking fear and anger among women? …

Perhaps FIB is only interested in speaking into their own echo chamber and putting out reports. And telling inflammatory stories designed to incite emotions but they are short on actions with others…

Those who are serious about this work are beyond writing click bait headline newsletters and blog posts that seem more designed to frighten and provoke doubt in a woman’s biological abilities than to educate.

I believe in educating mothers, not inciting fear about their bodies or weaponizing exclusive breastfeeding.

I believe in making sure physicians are properly trained in lactation, not from infant formula “Institutes” but from unbiased physician organizations such as the Academy of Breastfeeding Medicine …

Sears Allers implies that Dr. del Castillo-Hegyi and Ms. Segrave-Daly are demagogues, bullies and engaging in questionable practices, just like the FDA claimed about whistleblower Dr. Graham. What an amazing coincidence!

What are Sears Allers and the breastfeeding industry (“85 organizations”) afraid of? Unlike Merck, they aren’t merely afraid of losing market share; unlike the FDA they aren’t merely afraid of being revealed as more interested in promoting their product than promoting safety. They are most afraid of cognitive dissonance.

Seals Allers and the rest of the breastfeeding industry have built their self esteem on the notion that women who breastfeed are better mothers than those who don’t. It is important to them to be able to demonize women who formula feed as lazy, selfish, uneducated and under the sway of the formula industry. It is absolutely critical to them to lie to themselves and new mothers about the fact breastfeeding has serious risks as well as benefits.

The Fed Is Best Foundation has blown the whistle and they’re receiving the same treatment as whistleblowers in any industry. The Foundation is being smeared, the ethics and scientific acumen of the founders are being questioned, and vigorous efforts are being made to silence them.

Tragically these accusations are being used as a smoke screen to avoid addressing the problem that the Fed Is Best Foundation has brought to light: the preventable injuries and deaths of babies due to the very real and very serious risks of breastfeeding.

Considering the breathlessness of the news reports, you might imagine that the results of a new study tell us the best way to reduce SIDS.

According to the Daily News:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]If we want to reduce SIDS, our efforts should be applied to promoting pacifier use and discouraging co-sleeping.[/pullquote]

Babies who are breastfed for at least two months after they’re born reduced their risk of dying from Sudden Infant Death Syndrome by half, according to a new study…

The researchers are using their findings to call for “ongoing concerted efforts” to increase the rates of breastfeeding worldwide …

According to WebMD:

But the study also found moms don’t need to breast-feed exclusively to reap that benefit. Even partial breast-feeding will do, the 20-region study found.

“What is, perhaps, surprising is that there does not appear to be any benefit of exclusive breast-feeding over partial breast-feeding in relation to SIDS, though there are many other benefits associated with exclusive breast-feeding,” explained study author John Thompson, from New Zealand’s University of Auckland.

Tara Haelle, writing for Forbes, notes:

Any breastfeeding for 2-4 months reduces the risk of SIDS by about 40%. That means for every 10 non-breastfed babies who were going to die of SIDS, four of them would survive if all of them were breastfed instead.

That’s almost as much as the reduction in SIDS provided by pacifiers!

Breastfeeding and dummy use have a protective effect on sudden infant death syndrome by Alm et al. is a literature review on the protective effect against SIDS of both breastfeeding and pacifier use.

We found 11 observational studies that consistently showed a risk reduction of about 50% if the infant used a dummy.

There were also two meta-analyses that gave approximately the same odds ratio of about 0.5.

In other words, for every 10 non-breastfed babies who were going to die of SIDS, five of them would survive if all of them used pacifiers.

Breastfeeding your baby is nearly as good as a pacifier!

Of course, the protective effect of pacifiers or breastfeeding is dwarfed by the harmful effect of bed sharing. While pacifier use and breastfeeding appear to decrease the risk of SIDS by 50% and 40% respectively, bedsharing increases the risk of SIDS by 400% or more.

[I]n all 11 case-control studies reporting an association between bed sharing and SIDS, the risk of SIDS was increased in infants who bed shared; no study found a protective efect. The largest analysis to date was pub-lished in May 2013,91 with 19 studies from nine datasets across the UK, Europe, and Australasia and totalling 1472 cases of SIDS and 4679 controls. The individual level analysis showed that even for infants at low risk (that is, breast fed and with parents who neither smoked nor used illicit drugs or alcohol), bed sharing was associated with a fvefold increased risk of SIDS in the frst three months of life (adjusted odds ratio 5.1, 95% confdence interval 2.3 to 11.4), compared with infants placed for sleep in a supine position in a cot in the parents’ bedroom…

In other words, for every 10 babies who were co-sleeping when they died of SIDS, nearly nine of them would have survived had they been in their own beds.

Here’s a graphical representation of the relative benefits of breastfeeding, pacifiers, and putting the baby to sleep in his own bed:

It seems to me that if we really want to reduce SIDS, our “ongoing concerted efforts” should be applied to promoting pacifier use and discouraging co-sleeping.

Women who nurse their infants can be assured that breastfeeding helps a little bit, too.