It’s often easy to tell the difference between an expert and a quack.

• An expert has formal education in the topic at hand, while a quack has none.
• An expert understands both science and basic statistics and can reach an independent conclusion about the existing scientific evidence. A quack has to take the word of someone else.
• An expert recommends what’s good for YOU. A quack recommends what’s good for HER.
• Experts change their recommendations based on new scientific evidence. Quacks never change recommendations regardless of what the scientific evidence shows.
• Experts take responsibility for their recommendations. Quacks wash their hands of you, or even blame YOU when THEIR recommendations cause more harm than good.

It’s much harder to tell the difference between an expert and a quaxpert.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Quaxperts have professional qualifications and use them to peddle pseudoscience.[/pullquote]

What’s a quaxpert?

It’s a person who has professional qualifications in the relevant discipline, but nonetheless peddles pseudoscience. Since both experts and quaxperts have professional educations, degrees, titles and even scientific papers, how can the average person tell the difference?

Here’s are some handy tips to help you tell experts and quaxperts apart.

1. Quaxperts have “secret” knowledge: Beware when someone implies they are sharing secret medical knowledge with you. There is no such thing as secret medical knowledge. In an age where there are literally thousands of competing medical journals, tremendous pressure on researchers to publish papers, and instantaneous dissemination of results on the Internet, nothing about medicine could possibly be secret.

2. Quaxperts claim giant conspiracies: In the entire history of modern medicine, there has NEVER been a conspiracy to hide lifesaving information among professionals. Sure, an individual company may hide information in order to get a jump on competitors, or to deny harmful effects of their products, but there can never be a large conspiracy because every aspect of the healthcare industry is filled with competitors. Vast conspiracies, encompassing doctors, scientists and public health officials exist only in the minds of quaxperts.

3. Quaxperts often employ flattery: They try to flatter potential customers (quaxperts are always selling something, be it books, supplements or courses) by implying that those customers are uncommonly smart, insightful and wary. They portray non-believers as “sheeple” who are content to accept authority figures rather than think for themselves. A real medical professional does not need to flatter you. He or she knows what is true and what isn’t and shares that information whether it makes you happy or is the last thing you want to hear.

4. Quaxperts invoke toxins: I’ve written before that toxins are the new evil humors. Toxins serve the same explanatory purpose as evil humours did in the Middle Ages. They are invisible, but all around us. They constantly threaten people, often people who unaware of their very existence. They are no longer viewed as evil in themselves, but it is axiomatic that they have been released into our environment by “evil” corporations. There’s just one problem. “Toxins” are a figment of the imagination, in the exact same way that evil humours and miasmas were figments of the imagination.

5. Quaxperts often claim to be “brilliant heretics,” comparing themselves to Galileo or Darwin: They argue that science is transformed by brilliant heretics whose fabulous theories are initially rejected, but ultimately accepted as the new orthodoxy. The conceit rests on the notion that revolutionary scientific ideas are dreamed up by mavericks, but nothing could be further from the truth. Revolutionary scientific ideas are not dreamed up; they are the inevitable result of massive data collection. Galileo did not dream up the idea of a sun-centered solar system. He collected data with his new telescope, data never before available, and the sun-centered solar system was the only theory consistent with the data he had collected. Darwin also collected new data, which formed the basis of his theories about evolution.

6. Quaxperts love to baffle followers with scientific sounding bullshit: Quantum mechanics and chaos theory are two incredibly abstruse scientific disciplines, heavy on advanced math. If you don’t have a degree in either one, you aren’t qualified to pontificate on them. The same thing applies to new, imperfectly understood areas of science like epigenetics or the microbiome. Both are genuine scientific concepts, but we are in the earliest stages of elucidating them. Quaxperts like to invoke abstruse or poorly understood areas of science to justify quack theories.

There is a saying in science that “extraordinary claims require extraordinary evidence.” Quaxpert claims are typically extraordinary, but quaxperts don’t offer evidence, they offer “secret” knowledge, conspiracy theories, flattery and pseudoscientific nonsense. It’s designed to trick you into buying what they are selling, and quaxperts are invariably selling something. When you see one of these techniques, you can be virtually certain that you are in the presence of a quaxpert not an expert.

Run in the opposite direction.

Pediatrician Daniel Flanders doesn’t like the phenomenally successful Fed Is Best campaign. He made his feelings clear in a series of tweets.

After declaring:

#Fedisbest is an entirely unhelpful statement of the obvious. Beating heart is best. Functional brain is best. Breathing is best.”

He went on to claim:

it has evolved in a less helpful and more divisive direction. Lots of anti- breastfeeding rhetoric, “us vs. them” narratives, fear mongering.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]When you’re accustomed to privilege, leveling the playing field feels “divisive.”[/pullquote]

At first I didn’t understand what he meant but then I realized what he was getting at. Fed Is Best is divisive in the exact same way that feminism is divisive. When you’re accustomed to privilege, leveling the playing field feels “divisive.”

For example, members of the misogynistic men’s rights movement are constantly whining that feminism discriminates against them.

Men’s rights activists have rejected feminist principles and focused on areas in which they believe men are disadvantaged, oppressed, or discriminated against. In the 1980s and 90s, men’s rights activists opposed societal changes sought by feminists and defended the traditional gender order in the family, schools and the workplace. Some men’s rights activists see men as an oppressed group.

I have no doubt that MRAs really believe that they are victims but that doesn’t make it so. Their self pity doesn’t erase eons of brutal discrimination against women and it doesn’t change the fact that women are still disadvantaged in most parts of the developing world and even in some spheres in the industrialized world. Pretending you are being discrimated against may be a satisfying rhetorical tactic, but it is has nothing to do with reality.

Similarly, lactivists like Dr. Flanders are now whining that Fed Is Best is “divisive” and — irony of ironies — is responsible for an “us vs. them” outlook and fear mongering about breastfeeding. Never mind that a central, deliberate tactic of lactivism has been to promote guilt and shame by claiming ever more fanciful “benefits” of breastfeeding and dividing women into “good” mothers who breastfeed and “bad” mothers who don’t

No doubt Dr. Flanders, like many other professional lactivists, is sincere. When you have been given free rein to bully new mothers into breastfeeding, being forced to stop feels divisive, but, as in the case of the MRAs, the claims are a way to mask anger over loss of privilege not a reflection of the facts.

Indeed, when I asked Dr. Flanders to explain how and to whom is Fed Is Best unhelpful, he responded with his Donald Trump impersonation:

tooooooter!!! Are you looking for more blog fodder” you don’t need me to push your agenda. Go on without me.

How articulate — NOT!

I guess he was hoping a childish insult would hide the fact that he couldn’t answer the question; it doesn’t.

Fed Is Best has been a game changer because it is both empirically true — fully fed with formula is undoubtedly better than underfed with breastmilk — and because it addresses the oppressive lactivist tactics that have been deployed over the past two decades. In an effort to bully women into breastfeeding, lactivists have grossly exaggerated its benefits, ignored its life threatening risks, taken agency over their own bodies away from women by banning formula supplementation and pacifiers in hospitals and closing well baby nurseries.

There could not possibly be anything more divisive than breast is best rhetoric, yet lactivists, rather than acknowledging their mistakes, and apologizing for their tactics insist that forcing them to stop practicing divisiveness is somehow divisive.

Lactivists have behaved badly; women and babies suffered as a result. It’s not divisive to point that out; it’s simply a matter of compassion and common sense.

I’ve been writing for years that anti-vaccine advocacy has nothing to do with vaccines or even children. At its heart, anti-vax is a form of social identity; it’s all about parents and how they wish to view themselves.

Now comes a scientific paper, Parenting as politics: social identity theory and vaccine hesitant communities, by Attwell and Smith, that expresses a very similar view.

This paper argues that the decision to vaccinate or not is an inherently social one, not a matter of pure individual rationality. This is a novel approach to engaging with what is often characterised and studied as an individual decision.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It’s ironic that while anti-vaxxers like to preen about their independence from authority, they are desperately dependent on in-group validation.[/pullquote]

In other words, vaccine refusal has nothing to do with understanding of science (although anti-vaxxers do have a deficient understanding of science) and is therefore not amenable to change by improving knowledge about vaccines. It’s about group-think, belonging and a sense of empowerment derived from opposing the majority. It’s ironic that while anti-vaxxers like to preen about their independence from authority, they are desperately dependent on in-group validation.

…[V]accine hesitant people are often found in tight-knit geographical communities, they take comfort and inspiration from people who share similar beliefs all around the world, connected via the internet, with whom they feel a sense of kinship as an enlightened but besieged minority… [T]he social context of vaccination puts choices beyond the realm of pure individual rationality. The decision to vaccinate or not is tied to how individuals view society and their place in it, the social groups they value, and the shared worldviews of social groups they belong to.

But don’t anti-vaxxers come from widely different economic, social and religious backgrounds? They do, but the authors argue that these are simply tribes within the larger group.

There are various worldviews among these tribes, some of which are affluent and some of which reject materialism; some of which follow traditional religion and some of which favour non-traditional forms of spirituality. However, we suggest that all are formed in opposition to what they perceive as the damaging practices of modern mass society.

The commonality between the distinctive tribes is a “natural” approach to parenting and lifestyle.

People who adhere to this worldview value their own expertise and that of alternative health practitioners over mainstream medical and scientific expertise. They distrust what they see as unthinking deference to industrialised, commodified and financially co-opted medicine, and do not believe that the vaccinating mainstream has any valid claim on them or their children… [They] appear to hold specific beliefs around the damage of mass society as it pertains to the realm of health, and the health of their children in particular. When it comes to this, they seemingly do not aspire to acceptance from mainstream society; rather, they define themselves in opposition to it.

The authors use the insights of social identity theory (SIT):

SIT posits that individuals see the social world in terms of in-groups and out-groups, develop favourable biases towards members of their own in-groups, and make judgments about others based on this in-group bias.

That’s a remarkably apt description of anti-vax groups.

Ultimately, it’s about parental self-esteem, not vaccines and not children:

The individual drive for self-esteem is central to SIT. Individuals enhance their own self-esteem by their association with highly valued groups. They are therefore motivated to regard their own in-group highly, and to favour other members of that group. Degradation of out-group members may be a further means of enhancing in-group, and thus individual, self-esteem.

How are these groups created?

While historically this has relied upon physical proximity or tangible relationships, the internet and social media have opened up avenues for geographically disaggregated individuals to connect around ideas and practices.

The groups cohere around a particular cultural “style.”

[W]e posit that there is a recognisable identity to a central VHR tribe, referencing wellness and the pre-eminence of nature… [We] explore how this identity is reliant on particular resources. These resources enable an emphasis on individualism, which can be recognised as further attributes of this identity.

This style is closely tied to belief in “alternative” health, natural childbirth, breastfeeding, the centrality of nutrition.

Reich explicitly teased out how her mostly white, educated subjects in California saw feeding as “key to both their mothering and health promotion practice”, breastmilk was seen as conferring immunity, and on this basis mothers quasi-rationalised refusing vaccines, even while implicitly recognising that vaccination might be appropriate for other children. “[E]fforts to manage nutrition generally” were seen as “protective of […] children’s health”, whether because the mother took supplements during pregnancy or fed her child organic food.

Anti-vaxxers reject the notion that they have any responsibility to others:

To “live naturally”, one needs the resources of money or time, as we noted above; only then can one act and reason individually. This “me-first” perspective provides a salient rationale for dismissing the impact on others, as highlighting the special and unique properties of one’s own child makes it hard to justify population-level interventions…

In summary:

Vaccine hesitancy and refusal is also about one’s own self-image in relation to groups to which one perceives oneself as either belonging or proudly oppositional. Vaccine refusers possess the social or economic capital to define themselves against the mainstream, and seek to act according to their own beliefs and desires. Whether following a natural lifestyle and questioning big pharma, or using wealth to insulate one’s family from child care, bad food and “the riff raff”, VHR parents are able to separate themselves conceptually and physically from the rest of us.

Anti-vaxxers cling so desperately to their failed ideology, not out of concern for children’s health, but as a critical source of personal validation.

During my internship, I cared for Mr. R who developed leukemia as a result of successful treatment for lymphoma. His values and his experience of previous cancer treatment led him to insist that if the odds of cure were low, he wanted to return to his native island to die on the beach surrounded by his family.

He never got the chance.

His oncologist’s values and experience led him to believe that every chance of cure, no matter how remote, should be pursued aggressively. Therefore, he deliberately told Mr. R that he had a high chance of cure though he knew the chance was low. Mr. R consented to the treatment.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]UNshared decision making has become the standard of care in midwifery and breastfeeding support.[/pullquote]

Mr. R spent the remainder of his life vomiting, shaking with chills, and writhing in pain. Because of his damaged immune system, he was unable to fight a serious infection and it spread further even though we were treating it as aggressively as we possibly could. Three weeks after he was admitted, Mr. R died without ever leaving the hospital and without ever saying goodbye to his family.

The oncologist had engaged in UNshared decision making. Believing that he knew what was good for Mr. R, he tricked and pressured him into a treatment course that he did not want.

I suspect that we could all agree that UNshared decision making is unethical. So it’s rather surprising then that UNshared decision making has become the standard of care in midwifery and breastfeeding support. UK midwives enshrined UNshared decision making in the Campaign for Normal Birth and breastfeeding professionals have enshrined UNshared decision making in the Baby Friendly Hospital Initiative. Both represent violations of fundamental ethical principles.

Shared decision making is considered the pinnacle of ethical patient centered care.

As Michael J. Barry, M.D., and Susan Edgman-Levitan, P.A. explained in The New England Journal of Medicine in 2012:

The process by which the optimal decision may be reached for a patient at a fateful health crossroads is called shared decision making and involves, at minimum, a clinician and the patient, although other members of the health care team or friends and family members may be invited to participate. In shared decision making, both parties share information: the clinician offers options and describes their risks and benefits, and the patient expresses his or her preferences and values…

Critically, the patient is free to make a decision that is different than the one the provider might have made for her. Yes, it is true that the provider knows more about the medical implications of certain decisions, but only the patient herself knows her preferences and values and respecting those preferences and values are integral to providing ethical medical care.

They summarize shared decision making with a quote from a patient:

Nothing about me without me.

The Campaign for Normal Birth was until recently promoted by the Royal College of Midwives. Although the name has been changed to Better Births Initiative, the RCM has not changed its focus. Indeed, the primary goal featured on its website is:

Facilitating normal births for the majority and normality for all women.

In other words, the primary goal of the Better Births Initiative like the Campaign for Normal Birth before it is UNSHARED decision making. Like Mr. R’s oncologist, UK midwives have decided what is “best” for women without consulting women themselves. They insist that “science” shows that unmedicated vaginal birth is safest and therefore, they are justified in forcing it on every woman regardless of her experiences and values, and regardless of whether it is a realistic goal.

As Natasha Pearlman explained in Nightmare on the Maternity Ward a brilliant piece in the Times of London:

…[L]ooking back I would have expected to have been talked through some options: to be given a room, offered an induction, even just some simple advice on how to turn the baby.

The midwives did nothing. It seemed as if they had made the decision, without consulting me, to push me to the absolute limit to deliver the baby naturally. There was no option for me to change my mind. I was in a system out of my control…

Similarly, the Baby Friendly Hospital Initiative is based on UNshared decision making. Lactation professionals have decided what is “best” for mothers and babies without consulting mothers themselves. They insist that “science” shows that breast is best and therefore, they are justified in forcing breastfeeding on every woman regardless of her experiences and values, and regardless of whether it is a realistic goal.

Included among the Ten Steps of the BFHI are these:

Inform all pregnant women about the benefits and management of breastfeeding…

Give infants no food or drink other than breast-milk, unless medically indicated…

Give no pacifiers or artificial nipples to breastfeeding infants…

But shared decision making involves presenting the risks of breastfeeding — insufficient breastmilk, dehydration, failure to thrive — as well as the benefits. Shared decision making means that it is up to MOTHERS to determine whether to offer supplemental formula or pacifiers, NOT up to the provider.

Whether it is cancer treatment, childbirth care or breastfeeding support, decisions should be, as far as possible, based on SHARED decision making. The provider offers his or her assessment on options and outcomes and the patient chooses based on his or her values and experiences. By design, the patient should always be free to make a decision that is different from the one the provider recommended.

The Campaign for Normal Birth and the BFHI violate the imperative, “Nothing about me without me.” Both are deliberately based on UNshared decision making and that is wrong.

It was unethical when Mr. R’s oncologist deprived him of the opportunity to make a treatment decision based on his values and experiences. There is no possible justification for the suffering that Mr. R experienced as a result.

It is unethical when midwives and lactation professionals deprive women of the opportunity to make childbirth and infant feeding decisions based on their values and experiences. There is no possible justification for the suffering that mothers and babies experience as a result.

Pardon my language, but what the fuck is wrong with these people?

Millions in Texas have lost everything; they are crammed into shelters, wet, dirty, hungry. They are desperately trying to comfort and care for small children ripped from their routine with no idea when anyone can go back to their homes or if there is anything to go back to. Lactivists, observing this tragedy, have decided that this is the perfect time to … GLOAT.

Consider this abomination from La Leche League International:

Flooding? Power Outage?

Breastfeeding is perfect for all kinds of weather and can save you from having to go to the store during a flood or dangerous wind conditions. When power and water supplies are impacted in an emergency, breastfeeding can be a lifesaver.

Or how about this lie packed gem from a Facebook page set up specifically to “protect” breastfeeding during Harvey?

Actually stress CAN cause milk supply to drop precipitously. So can limited access to food and water.

Moreover, women running for their lives don’t have time to breastfeed continuously and may — shocking I know — have other children as well as disabled or elderly relatives they need to provide for as well.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]In the midst of tragedy, lactivists have decided that this is the perfect time to gloat.[/pullquote]

The motto of the Facebook page is S.A.F.E.: Support, Assess, Feed, Empower.

Pardon my language again, but have they lost their fucking minds? In the midst of a natural disaster, the priorities should be Rescue, Feed, Shelter. It doesn’t matter how babies are fed in a natural disaster, only that they ARE fed.

What are lactivists trying to accomplish?

It isn’t feeding babies. Babies that are aren’t being breastfed and currently starving for lack of formula can’t get breastmilk since breastfeeding isn’t a faucet you can turn on and off at will. It isn’t protecting breastfed babies whose mothers have experienced a decrease in supply because of the extraordinary stress of life threatening events since they don’t have access to anything that could help them increase their supply. And it isn’t protecting breastfed babies who are doing well with exclusive breastfeeding since they don’t need any help.

The folks at LLL and Safely Fed USA are gloating, imagining that their babies would be protected from hunger during a natural disaster. It’s the equivalent — in heartlessness and self-absorption — of boat manufacturers chiding those who are drowning for lack of a boat: Boats are perfect for hurricanes and can save you from having to be rescued by others. In the midst of this hurricane don’t you wish you had a boat?

And pardon my language one more time, but what the fuck is wrong with the folks at the American Academy of Pediatrics?

They’ve given us this piece of garbage.

Pro tip: The middle of a natural disaster is not the time to wax poetic about the virtues of breastfeeding. Pediatricians should not be supporting breastfeeding; they should be supporting babies.

Advocate for optimal feeding options for orphaned infants, including HIV- donor milk.

Have the folks at AAP lost their collective minds? When people are drowning in the streets, there is no way they can access donor milk. It’s the equivalent of insisting that starving older children an adults should restrict themselves to organic food or not eat all while homeless.

… Powered formula is a last resort.

Bullshit! Powdered formula prepared with clean water is equally effective as breastmilk in keeping babies in disaster areas alive.

Lactivists, LLL and the AAP should be ashamed of themselves!

Here’s a thought: if lactivists are so concerned about babies being deprived of breastmilk during Harvey, why don’t they head down to Houston area shelters and breastfeed as many babies as you can.

Male or not currently lactating female? Learn to lactate. No doubt you could do it if you try hard enough.

Oh, right. You’re not interested in sacrificing to help others, just gloating in the face of those experiencing tragedy.

One of the most pernicious of the many pernicious aspects of breastfeeding promotion is the insistence by lactation consultants that all women can make enough breastmilk to fully nourish an infant.

Not only is it factually false, but it has given impetus to two additional erroneous beliefs:

1. Insistence that low supply is a misperception on the part of the mother

2. Belief that documented low breastmilk supply, and the relentless infant hunger that results, is the mother’s fault.

The assumption (sometimes stated, often implied) is that women who have low supply aren’t trying hard enough, aren’t breastfeeding often enough and long enough, aren’t pumping enough, shouldn’t have had an epidural or C-section, never should have let the baby have a pacifier, etc.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Low breastmilk supply is as real as diabetes. [/pullquote]

These are incredibly harmful beliefs. First, they hurt new mothers who are desperately trying to breastfeed without success. The only thing more devastating than hearing your baby scream incessantly from hunger is being told that it is only your imagination or worse, the result of your selfishness. It’s the equivalent to insisting that those with type I diabetes lack insulin because they are too lazy to produce it.

Fortunately, within the past year or so, increasing attention has been paid to the harmful impact of such claims on maternal mental health. Women have been sharing their stories of guilt, shame and depression and pushing back against the overwhelming pressure to breastfeed exclusively.

The second harmful aspect of such beliefs often goes overlooked. By insisting that low breastmilk supply is imaginary or simply a matter of maternal effort, lactivists have systematically failed to investigate biological causes of low supply. That’s the equivalent to refusing to look for a cause of type I diabetes and blaming diabetics instead.

The truth is that low breastmilk supply (like diabetes) is real, is no one’s “fault” and has a biomarker to prove it.

Earlier this year I wrote about the discovery of a biomarker for low breastmilk supply: high sodium concentration within breastmilk.

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. This association has subsequently been confirmed.Several possibilities have been suggested as to the cause of increased sodium levels in breast milk… It has been shown that sodium values are not affected by the mother’s diet or by the method of milk expression …

Subsequent research demonstrated that women who expressed concerns about breastmilk supply were more likely to have the biomarker than women who did not.

If concerns about milk supply among exclusively breastfeeding women were primarily owing to a lack of knowledge about the signs of abundant milk production, then the expected outcome would be no difference in breast milk Na:K as compared with exclusively breastfeeding women without milk supply concerns… Instead, the observed prevalence of elevated Na:K was 2-fold greater in the mothers with milk supply concerns (42% vs 21%)… This result challenges the belief that milk supply concern in the context of exclusive breastfeeding is primarily maternal misperception.

These findings also challenge the belief that all women make enough breastmilk to fully nourish an infant and it is their fault if they don’t.

Now comes evidence of a genetic basis for low milk supply. Milk cell gene expression of mothers with low breast milk production is a basic science paper with important clinical implications. It was funded by a grant from Medela AG, a maker of breast pumps.

Initial analysis found cells isolated from women with low milk production showed significantly lower expression of the genes estrogen related receptor beta (ESRRB, p=0.027) and neurotrophin receptors sortilin (SORT, p=0.010) and tyrosine receptor kinase 2 splice variant 1 (TRKB1, p=0.007) and higher expression of a progenitor marker (REX1, p=0.025) compared with cells isolated from women with normal production.

The authors concluded:

Preliminary findings suggest variations in cell signalling and function, examined through gene expression that might contribute to low milk production. Further investigations will potentially determine significant roles of key genes enabling successful human lactation.

This shouldn’t be surprising. Genes control everything from height to eye color to susceptibility to disease. Why wouldn’t they also control breastmilk supply?

By investigating the biological basis for low milk supply we can find the cause and, hopefully, a cure. Alternatively, we may find that as with type I diabetes, no cure is currently possible, and supplementing (with insulin in diabetes, with formula in low breastmilk supply) is the only course of action. In either case, it should relieve the stigma on new mothers with low supply.

Low breastmilk supply is as real as diabetes and it poses a substantial health threat to infants. It’s not a mistaken maternal perception; it’s not mothers’ fault; and it can’t be fixed with greater maternal effort.

It’s almost certainly genetic.

Psychological defense mechanisms are strategies that protect people from emotional distress:

[They are] brought into play by the unconscious mind to manipulate, deny, or distort reality in order to defend against feelings of anxiety and unacceptable impulses and to maintain one’s self [image].

Denial is one of the most primitive and most powerful defense mechanisms:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Homebirth advocates insist they are taking responsibility for their baby’s health … right up until the baby is harmed by their choice.[/pullquote]

Refusal to accept external reality because it is too threatening; … resolution of emotional conflict and reduction of anxiety by refusing to perceive or consciously acknowledge the more unpleasant aspects of external reality.

Denial is one way that women whose children have been harmed at homebirth try to avoid responsibility for the harm that resulted from their decision. For example:

I want everyone to realize something…because I was asked again today if I still agree with home birth. Let me make this clear…what happened with M would have happened in the hospital too!! Group B strep can go undetected and then when baby tries to breathe, they just can’t. It had NOTHING to do with birthing her at home! And arguing with me that she would have had better and quicker care in the hospital is bogus too. My midwife immediately began exactly what doctors would have done (minus cutting the cord as that is what was literally keeping M alive!). Doctors would have done neonatal resuscitation and oxygen first as well. Then moved on to ventilator. THIS WAS DONE!! Homebirth does not mean we birth in a cave with no emergency supplies. So stop asking me if I still agree with homebirth!
I AM 100% STILL IN SUPPORT OF HOMEBIRTHS AND I WILL ALWAYS RECOMMEND THEM TO WOMEN.
Again, homebirth did NOT cause M’s struggles…a horrible horrible infection did that.

I wrote about this mother and baby a few weeks ago, Another baby grievously harmed by homebirth; another mother desperately pretending it’s not her fault.

She was in denial then and she’s still in denial now.

This would likely not have happened in the hospital for a variety of reasons, but the most important one is this: we now test women for group B strep bacteria at the end of pregnancy and elaminate it before it can infect a baby by giving antibiotics in labor. The results have been remarkable:

The incidence of invasive early-onset GBS disease decreased by more than 80% from 1.8 cases/1000 live births in the early 1990s to 0.26 cases/1000 live births in 2010; from 1994 to 2010 we estimate that over 70,000 cases of EOGBS invasive disease were prevented in the United States.

Why didn’t M’s mother know she was colonized by group B strep and her baby was a risk of a brain threatening, life threatening infection? Because she declined the group B strep test at the end of pregnancy and therefore was not treated with antibiotics during labor.

But that’s not the only serious complication that Baby M suffered as a result of her mother’s choice to put her life at risk at homebirth.

She was deprived of oxygen during labor.
She inhaled meconium.
She needed an expert resuscitation with intubation.
She was unexpectedly breech.

Each factor ratcheted up the risk. Each factor was unknown or ignored at home and would have been treated very differently in the hospital.

The breech position would almost certainly have been diagnosed before labor and the mother offered an elective C-section; had she taken it, the baby would not have suffered a severe insult to her brain.

The oxygen deprivation during labor would almost certainly been diagnosed during labor by the use of electronic fetal monitoring. EFM has a very low false negative rate; it almost never misses actual fetal distress. Doctors would have recommended an emergency C-section and the baby would not have suffered a brain injury.

The meconium would have been taken into account in a diagnosis of fetal distress. Had the mother consented to an emergency C-section, the baby might not have inhaled meconium or would not have inhaled as much.

The baby would have received an expert resuscitation, intubation and immediate treatement with antibiotics to minimize any injury in progress.

What about the mother’s claim that it was delayed cord cutting that kept baby M alive? That’s nonsense. The problem was that baby M was not getting enough oxygen in utero. That’s why there was meconium; that’s why the baby inhaled it; that’s why the baby was born not breathing; the brain injury was already in progress. The idea that delayed cord clamping was lifesaving is foolish; it wasn’t providing enough brain preserving oxygen before the baby was born, it certainly wasn’t providing any more after the baby was born.

Homebirth advocates often insist that by choosing homebirth they are taking responsibility for their baby’s health … right up until the baby is harmed by their choice. Women who choose homebirth do so because they believe that routine hospital interventions are almost never needed. Yet when a baby is born injured because she did need those routine interventions but was deliberately deprived of them, many homebirth mothers retreat into denial. All of a sudden nothing is their responsibility; everything supposedly would have happened exactly the same way in the hospital.

Denial, as powerful as it is, rarely lasts forever. There will almost certainly come a time when the mother will have to reckon with what she did: she made a choice that profoundly harmed her baby and both she and her baby will wake up to that horrible reality every day for the rest of their lives.

Think homebirth is safe? Think again.

There’s an old saying that if you only have a hammer, everything looks like a nail. It means that if you only know how to do one thing, you will insist that is what needs to be done.

Consider, for a moment, the possibility that there was a handyman, Bob, who only knew how to use a hammer. Whenever he was called to a job, he brought his trusty hammer and banged in the nails. Imagine that a new handyman, Steve, comes to town and he knows how to use a hammer AND a screwdriver. He can do twice as much as the original handyman and as time goes by, more and more people call Steve, since many of their projects involve nails and screws.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Normal birth has nothing to do what is normal and almost nothing to do with birth. It’s all about midwives controlling patients.[/pullquote]

Bob, the original handyman, now faces a difficult choice. What should he do about jobs that involve screws? There are several tacks that he could take:

He could always learn to use a screwdriver, but that might be difficult for Bob. What else might he do?

He could insist that screws can be pounded in.
He could insist that screws are an unnecessary use of technology; anything that can be made with screws could also be made with hammers.
He could insist that Steve invented screws just to take business away from him.
He could insist that Steve recommends screws for a project when nails would have been just fine.

Or he could take the aforementioned claims to their logical conclusion:

He could insist that only things assembled with nails are normal.

All of these strategies share one thing in common. They imply that being able to use a screwdriver is unnecessary regardless of the situation.

This is not a real world situation, of course; it is an analogy. Midwives are the people with hammers. Normal (or natural) birth is nails and screws are anything that obstetricians can do that midwives can’t.

There has a been a lot of debate in midwifery circles about what exactly constitutes normal birth.

As anthropologist Margaret MacDonald explains in the Lancet, The cultural evolution of natural birth:

Natural birth has long held iconic status within midwifery and alternative birth movements around the world that have sought to challenge the dominance of biomedicine and the medicalisation of childbirth… The recent transition of midwifery in several Canadian provinces from a social movement—for which “reclaiming” natural birth was a critical goal — to a regulated profession within the formal health-care system is a unique opportunity to track changes in how natural birth is understood and experienced. Midwifery in Canada has much in common ideologically with independent or direct-entry midwifery in the USA and with radical and independent midwifery in the UK and so insights about changes in Canada have implications for maternity caregivers in a range of health systems.

Normal birth actually involves lots of technology. There is nothing natural about checking blood pressure, listening the fetal heart with a Doppler or recommending chiropractic. Other technological interventions have also become a part of normal birth:

… For example, a woman asks to have her membranes artificially ruptured after several hours of labour to “get things going” and gives birth vaginally at home… The presence of medical interventions within the realm of natural birth is a relatively common kind of border crossing.

Midwives will also recommend herbs or over the counter medications like castor oil to stimulate labor and prevent a term pregnancy from extending into a higher risk postdates pregnancy. In fact:

[If an intervention] can bring back the clinical normalcy of the labour pattern and keep it within the midwifery scope of practice, it is generally regarded as a good thing by midwives  … (my emphasis)

That is the key point. Anything is acceptable as long as it can keep the birth within the scope of midwifery practice. Normal birth has nothing to do what is normal and almost nothing to do with birth. It’s all about midwives controlling patients.

Just like Bob the handyman, a midwife faces a difficult situation when confronted with a patient who needs advanced technology like a C-section. She also has several choices, remarkably like the choices from which Bob can choose.

She could insist that the patient can give birth safely without a C-section.
She could insist that C-sections are an unnecessary use of technology.
She could insist that obstetricians recommend C-sections just to take business away from midwives.
She could insist that obstetricians routinely recommend C-sections when vaginal birth would have been just fine.

Or she could go “all in”:

She could insist that only vaginal birth is normal.

Proponents of radical midwifery theory use all these strategies. Midwives define normal birth by what is good for THEM, not what is good for women or safe for babies, and certainly not by what is actually normal.

A baby is breech and the midwife can’t do either a version or a C-section for breech. She insists that breech is a variation of normal.

A baby is postdates and the midwife can’t do a postdates induction with pitocin. She insists that babies aren’t library books and they don’t have to be born on a specific date and for good measure, she insists that pitocin causes ADHD, autism, or whatever condition you might fear.

A woman experiences severe pain during labor and a midwife cannot administer an epidural. She insists that the pain is beneficial, that the epidural has too many “risks” and that pain relief hurts the mother’s ability to bond with her baby. (Interestingly, in the UK where midwives can administer nitrous (an anesthetic) by mask, nitrous is considered compatible with normal birth.)

I could go on and on, but you get the idea. Anyone working with a midwife enamored of radical midwifery theory needs to ask herself: Are my midwife’s recommendations motivated by what it good for me and safe for my baby? Or are my midwife’s recommendations motivated by what will allow her to maintain control of me as a patient?

Does “normal birth” actually mean anything, or is it just a way for midwives to make what they can do seem most desirable?

Personally, I think the answer is clear. Normal birth has nothing to do with normal and nothing to do with birth. The definition of normal birth is simple and straightforward: If a midwife can do it, she calls it normal. If she lacks the skill to provide the needed care, she insists that the birth is not normal even if it results in a healthy mother and a healthy baby.

We’d rightly be suspicious of a handyman who asserted that assembling everything with a hammer is best. We should be equally suspicious of a midwife who insists that every woman wants, needs and benefits from normal birth.

In the last few years a deadly disorder that we thought was vanquished has begun to reappear.

The disorder is hemorrhagic disease of the newborn, also known as vitamin K deficiency bleeding. It can lead to life hemorrhage into the infant gut, and neurologically threatening hemorrhage into the infant brain.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Natural childbirth advocates were dead wrong.[/pullquote]

Why did it make a comeback? Because natural childbirth advocates declared that newborn vitamin K injections were both unnecessary and dangerous.

They were dead wrong.

From The Tennesean in 2014:

A bleeding disorder in babies so rare that it typically affects fewer than one in 100,000 is becoming more common in Tennessee because parents are refusing vitamin K injections at birth, according to pediatric specialists.

Since February, four babies with no signs of injury or abuse have been sent to Monroe Carell Jr. Children’s Hospital at Vanderbilt with either brain hemorrhages or bleeding in the gastrointestinal tract…

What happened to the babies?

All four children survived, but the three who suffered brain bleeds face challenges.

“These are kids that end up having surgery to remove the large amount of blood out of their head or they would have died,” he said. “It’s early. It’s only since February, but some of the kids have issues with seizure disorders and will have long-term neurological symptoms related to seizures and developmental delays.”

Vitamin K deficiency bleeding is remarkably easy to prevent with just simple injection of vitamin K shortly after birth. Yet on the advice of natural childbirth advocates, including some midwives and doulas, mothers began refusing the lifesaving injections.

It’s hardly surprising that natural childbirth were wrong since there was never any scientific evidence to dispute the vital role of vitamin K injection and no scientific evidence that it caused harm. Nonetheless natural childbirth advocates labeled it an intervention and with typical natural childbirth “logic” concluded that it must be unnecessary.

In an interview, Rebecca Dekker, of Evidence Based Birth, acknowledges that these injuries and deaths were both entirely preventable and caused by irresponsible claims. Dekker unwittingly gives a primer on the classic logic fails that lead to deadly advice irresponsibly offered by natural childbirth providers and irresponsibly followed by parents.

Logic fail #1: I haven’t seen it so it must not be a problem.

I knew that Vitamin K deficiency bleeding (VKDB) was rare, but I didn’t realize—until I started reading the research—how effective the shot is at basically eliminating this life-threatening problem.

Like most natural childbirth advocates, Dekker had no clue that a particular complication is rare because of interventions, not rare in nature.

Logic fail #2: I pride myself on being “educated,” although in reality I am ignorant.

…[T]here is this misconception that “Vitamin K doesn’t have any evidence supporting its use,” and I found that belief is totally untrue. There is a lot of evidence out there. People have just forgotten about it or not realized it was there.

Logic fail #3: If I am practicing natural parenting, my baby won’t need interventions.

That the two main risk factors for late Vitamin K deficiency bleeding (the most dangerous kind of VKDB that usually involves brain bleeding) are exclusive breastfeeding and not giving the Vitamin K shot.

Parents who have been declining the shot are the ones who are probably exclusively breastfeeding. So their infants are at highest risk for VKDB.

Logic fail #4: Inteventions by definition are always unnecessary.

There are so many misconceptions and myths. I’ve heard them all. The scary thing is, I’ve heard these misconceptions from doulas and childbirth educators—the very people that parents are often getting their information from. I’ve heard: “You don’t need Vitamin K if you aren’t going to circumcise.” “Getting the shot isn’t necessary.” “Getting the shot causes childhood cancer.” “Getting the shot is unnatural and it’s full of toxins that will harm your baby.” “You don’t need the shot as long as you have delayed cord clamping.” “You don’t need the shot if you had a gentle birth.”

Logic fail #5: Ignore doctors and do your own “research.”

… It is truly alarming the things that parents are reading. “Vitamin K leads to a 1 in 500 chance of leukemia.” “Vitamin K is full of toxins.” Most of the articles on the front page of results are written by people who have no healthcare or research background and did not do any reference checking to see if what they were saying was accurate. It’s appalling to me that some bloggers are putting such bad information out there.

If parents don’t trust the evidence, it may be because they have read so many of these bad articles that it’s hard to overcome the bias against Vitamin K. All I can say is, given the number of bad articles on the internet about Vitamin K, I can totally understand the confusion people have.

Logic fail #6: Believing natural childbirth advocates are knowledgeable, unbiased sources of information.

I mean, even I was confused before I started diving into the research! I truly went into this experience with no pre-existing biases. I just wanted to figure out the truth. If even I—the founder of Evidence Based Birth—didn’t know all the facts about Vitamin K, then I think that’s a pretty good sign that most other people don’t know the facts, either!

Dekker flatters herself. She started with a preexisting bias: reflexive distrust of doctors, scientists and government health agencies; she assumed they could not be trusted to determine that vitamin K is the best way to prevent bleeding from vitamin K deficiency.

Logic fail #7: My doula told me, so it must be true.

I don’t think we are doing a very good job with the parents who decline the shot, either. If you read the part of my article where I wrote about the epidemic in Nashville, all of the parents refused the shot, but none of the parents gave informed refusal. All of them had been given inaccurate information about the shot, so they couldn’t make a truly informed decision. Can you imagine what it must be like for the people who gave them the inaccurate information? That would be so terrible to know that your misinformation may have led to the parents making the choice that they did.

No shit, Sherlock!

Sadly, Dekker does not acknowledge that it is the logic fails so beloved of natural childbirth advocates that led to these preventable injuries and deaths. The reflexive distrust of physicians and scientists, the basic ignorance of science and the bias against interventions all combined to convince parents that refusing the vitamin K shot was “educated” when it was in fact deadly.

Which brings us to the biggest take home lesson of all: If natural childbirth advocates (including some midwives, doulas and childbirth educators) could be so wrong about something so simple — that vitamin K injections safely and reliably prevent vitamin K deficiency bleeding — should their advice ever be trusted?

Of course not.

I’ve spent the past 12 years writing about the dangers of radical midwifery and lactivism. Surprising, I recently acquired powerful new allies: midwives and lactivists themselves. Their mind boggling tone-deafness in responding to media criticism reinforces — in a truly nauseating way — the central point of all my writing:  natural childbirth advocates and lactivists really don’t care that their ideologies harm babies and mothers.

In the UK, midwives were recently forced to shutter their Campaign for Normal Birth in the wake of scores of preventable deaths of babies and mothers, multiple investigations placing responsibility of midwifery ideology, and nearly £2 billion in insurance payouts in the past year alone.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It’s hard to imagine that anyone could be as tone deaf as Godfrey-Isaacs and Martinez-Sullivan in addressing preventable infant deaths, but I for one am grateful. They are doing my work for me![/pullquote]

If UK midwifery were devoted to improving outcomes for babies and mothers, we should have seen a public apology, a promise to learn from their mistakes, outreach to the families of those harmed by their ideology, and dramatic changes in policy. Instead we’ve gotten claims that dead babies are “fake news,” insistence that midwives will go on promoting the very policies that killed mothers and babies, and, above all, self absorption and self pity.

UK midwives are channeling Donald Trump: responding to facts that show them in a negative light by ignoring those facts, labeling them “fake news,” berating the media, and insisting they are being persecuted.

Consider this response, Birth (and midwives) in the media, from Laura Godfrey-Isaacs, “midwife, artist and feminist academic & activist”.

Godfrey-Isaacs starts off thus:

We will all experience a ´media-informed´ birth wrote Fleming et al in 2014, with information that is ´fragmented, weakly linked and poorly referenced´ – how pertinent this seems of the journalism displayed in major UK newspapers in August 2017, and how it highlights the responsibility journalists have to portray birth in a balanced way, as most women will not witness birth before they are in labour.

In 2016, I undertook an extensive literature search examining birth in the media since the 1980s. I identified the same themes. They are very much in evidence as you trawl through the articles. These themes have been seen to reinforce certain dominant ideologies and narratives of birth, as well as around motherhood and gender.

In a piece that is ostensibly a response to the reports that scores of babies have been injured or died on the altar of midwifery ideology, Ms. Godfrey-Isaacs can’t be bothered to mention preventable deaths of babies and mothers. Indeed, in a piece of over 1400 words, Godfrey-Isaacs doesn’t mention dead babies beyond chastising the media for reporting them.

I invite you to read Godfrey-Isaacs piece for yourself, but suggest that you take an anti-emetic beforehand. It’s hard not to vomit when you realize that ideological cant and extreme self-absorption betray a horrifying reality; midwives apparently think they — not dead babies and dead mothers — are the victims.

Thank you, Ms. Godfrey-Isaacs, for demonstrating vividly that normal birth ideology isn’t about what’s good for babies, but what’s good for midwives. Thank you for further demonstrating that it doesn’t matter how many people die as a result, midwives will continue to promote THEIR OWN best interests.

Lactivists have recently been confronted with a similar problem — an ideology that purports to be about what’s best for babies is killing babies. The problem is so widespread that the American Academy of Pediatrics has repeatedly called attention to the fact that breastfeeding promotion efforts ignore scientific evidence and lets babies die — from hypoglycemia, dehydration and starvation — on the altar of lactivism.

The Fed Is Best Foundation was formed by Christi del Castillo-Hegyi, MD and Jody Segrave Daly, RN, IBCLC, specifically to prevent injuries and deaths from aggressive breastfeeding promotion. Their message has resonated both with mothers (400,000 following their Facebook page) and the media, which has highlighted stories of preventable tragedies cause by the insistence that breastfeeding is always best even when it is killing babies.

The success of the foundation has led to an outpouring of vitriol. That hasn’t been very effective so lactivists organizations are trying a different tack, Moving Forward to Constructive Dialogue, by Lucy Martinez-Sullivan of 1000 Days, as if the appropriate response to preventable infant deaths is to discuss them instead of prevent them.

Dr. del Castillo-Hegyi had called 1000 Days to account for publicly chastising an organization that provides formula to babies whose mothers are DEAD. Just as in Mosul, where babies are dying due to lack of formula, lactivists are attempting to PREVENT them from getting life saving formula.

As Gayle Tzemach Lemmon, senior fellow at the Council of Foreign Relations pointed out:

Promoting breastfeeding is a laudable goal, but in some cases, international policy ends up determining women’s on-the-ground reality, even in wartime settings, rather than the other way around. In the process, policies run the risk of treating nursing mothers as children themselves, whose needs are best known by global policy makers sitting thousands of miles away, not doctors and humanitarians nearby doing their best to help.

How does Martinez-Sullivan respond to similar criticism of 1000 Days? With ideological cant:

…[T]he aggressive promotion of infant formula in sub-Saharan Africa and other impoverished parts of the world in the 1970’s led to a rise in infant deaths and horrific cases of malnutrition. This became an international scandal when the UK charity War on Want published their ground-breaking report “The Baby Killer” in 1974 which detailed how “more and more Third World mothers are turning to artificial foods during the first few months of their babies’ lives. In the squalor and poverty of the new cities of Africa, Asia and Latin America the decision is often fatal.”

What does the fact that fifty years ago formula companies convinced mothers who were successfully breastfeeding to switch to formula have to do with babies starving today for lack of breastmilk? Absolutely nothing except to burnish the ideological cred entails of Martinez-Smith and her organization. No matter, ideological purity is apparently more important than whether babies lives or die.

Martinez-Sullivan insists:

While opposing the aggressive and unethical promotion of breastmilk substitutes, 1,000 Days supports the safe and appropriate use of infant formula when necessary in accordance with the World Health Organization’s infant feeding recommendation.

Here’s a thought, Ms. Martinez-Sullivan, when you find yourselves letting babies die in order to promote what’s “best” for them, you might consider that you aren’t promoting what is best for them.

In my view, the entire episode is yet another example of lactivists trying to discredit the Fed Is Best Foundation for having the temerity to point out that lactivist campaigns are killing babies.

I understand if you do not wish to meet with me or 1,000 Days because of what I wrote in response to the aforementioned post. But please do not let that be the reason you decline the invitation to meet with the 43 other organizations that represent parents, physicians, health professionals and volunteers working tirelessly to help families give kids the strongest start to life and that signed the letter sent to you seeking a constructive dialogue with the Fed Is Best Foundation… 1,000 Days does however stand together with these groups in genuinely wanting to explore if there is common ground with the Fed Is Best Foundation when it comes to providing families with accurate and unbiased information on infant feeding.

But why should the Fed Is Best Foundation want to meet with 43 other organizations that have publicly opposed their effort to save babies lives? What is there to discuss when these organizations think that process is more important than outcome? Unless and until lactivist organizations acknowledge the preventable deaths that have occurred as the result of their commitment to ideology and, more importantly, take aggressive steps to prevent further deaths, there’s really nothing to say …

Except thanks Ms. Martinez-Sullivan for demonstrating that lactivism isn’t about what’s good for babies, it’s about what’s good for lactivists. Thank you for further demonstrating that it doesn’t matter how many babies die as a result, lactivists will continue to promote THEIR OWN best interests.

It’s hard to imagine that anyone could be as tone deaf as Godfrey-Isaacs and Martinez-Sullivan in addressing preventable infant deaths, but I for one am grateful. They are doing my work for me!