Childbirth and breastfeeding have been hijacked by WEIRD women.

No, I don’t mean that natural childbirth advocates and lactivists are weird, they’re WEIRD: Western, educated, and from industrialized, rich, and democratic countries. It’s a term from psychology highlighting the fact that the bulk of psychology research is done on Western, educated people from industrialized, rich, and democratic countries and therefore, should not be extrapolated to everyone else.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]WEIRD women view themselves as setting the standards for childbirth and breastfeeding to which other women should aspire.[/pullquote]

There’s nothing wrong with being WEIRD; I’m WEIRD myself. There is something wrong with imagining that being WEIRD makes you a role model for others or entitles you to speak for everyone else. Sadly, that’s just what has happened in the realm of childbirth and breastfeeding:

WEIRD women believe unmedicated vaginal birth and breastfeeding are best. They insist that the scientific evidence supports their beliefs, but in fact those beliefs are often logical fallacies or based on scientific research that is riddled with confounders. For example, claiming that unmedicated vaginal birth is safest is like claiming that those who don’t take blood pressure medications are healthiest. The correlation is real, but they’ve confused cause on effect.

Sure, those who don’t need blood pressure medications are often healthier than those who do, but banning blood pressure medications will not make people with high blood pressure any healthier; indeed it will make them sicker. And waiting until someone is in the midst of a heart attack or stroke to treat their high blood pressure will not decrease heart attacks of strokes; it will just increase serious injuries and deaths.

Sure, women who don’t need interventions in childbirth often wind up with fewer complications than women who do need them, but banning interventions in childbirth will not make people who need them any healthier; indeed it will make them sicker. Waiting until someone is in the midst of an obstetric crisis to use interventions will not improve outcomes; it will just increase serious injuries and deaths. That’s exactly what happened as a result of the UK Campaign for Normal Birth; it was inevitable.

Sure, women who can breastfeed exclusively often have children who are healthier, but that’s because women who can breastfeed exclusively have adequate supply, someone to support them while they step outside the workforce to breastfeed (or a job that allows them to pump), and are typically WEIRD, having more money, greater education and better access to healthcare. Demonizing formula use, as embodied by the Baby Friendly Hospital Initiative doesn’t make babies healthier; it makes many of them sicker. And waiting until a baby is hypoglycemic, dehydrated and or jaundiced to supplement with formula does not improve outcomes; it increases injuries and deaths.

WEIRD women insist that anyone who might want to use technology in childbirth (epidurals, fetal monitoring, C-sections) or infant feeding (formula) is either uneducated or brain washed. They imagine themselves as the ideal to which other women should strive. Therefore, any woman who is not striving toward that ideal hasn’t been properly instructed or is being duped by culture of industry.

There is a great deal of academic work in midwifery that attempts to place blame for the fact that most women don’t want unmedicated vaginal birth without interventions. Grantly Dick-Read, the father of natural childbirth, insisted that it is culture that causes women to believe that they want pain relief in childbirth. Contemporary midwives and natural childbirth advocates blame medicine for promoting technology, the media for (accurately) presenting childbirth as both painful and dangerous, and male physicians who wish to commit “obstetric violence.”

There is a great deal of academic work in lactivism that attempts to place blame for the fact that many women can’t or don’t wish to breastfeed. The villain of choice in these scenarios is the formula industry, an industry that engaged in villainous conduct in the developing world in the 1970s. But the unethical conduct of formula companies in the past had nothing to do with the safety of formula. Promoting formula in the developing world can lead to infant illness and death because the water used to make it was often contaminated. Formula companies behaved in an immoral fashion, but there is nothing immoral about formula.

WEIRD women practice medical colonialism by claiming to emulate indigenous women and by lobbying international health organizations like the WHO and UNICEF to promote WEIRD beliefs in developing countries. Sadly, WEIRD women are often motivated by a sense of class and race superiority. On the one hand, natural childbirth advocates and lactivists have created with an exoticized view the poor indigenous Other (generally black or brown) and claim to be emulating them. On the other hand, they are pleased to distinguish themselves from the poor industrialized Other within their own countries (both black and white) whom they conceptualize as ignorant and lazy.

Medical colonialism isn’t merely morally repugnant, it actually kills babies. Consider the plea from Doctors Without Borders begging for formula for infants in Mosul as reported by CNN, Don’t make babies rely on breastfeeding in war zones:

The mothers who need [formula] are those facing down life-and-death situations each day, often while caring for multiple children in the shadow of war. That giving infant formula to them is so controversial speaks to a policy tripwire few outside the humanitarian realm even know exists: global “breastfeeding first” policies.

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.

WEIRD women practice medical paternalism, imagining that unmedicated vaginal birth and exclusive breastfeeding must be promoted as standards to which all women should be forced to achieve. Contemporary midwifery and lactivism are all too often based on the notion that midwives and lactivists know better than women themselves. In a bitter irony, midwifery and lactivism have exchanged the patriarchy for the matriarchy.

That doesn’t mean that contemporary female arbiters don’t believe completely in their view of childbirth; they do. But believing in the value of paternalism does not justify paternalism.

In countries like the UK where midwives are gate keepers of maternity care, it is the midwife who determines whether a patient needs pain relief and whether she gets it, not the patient. It is the midwife who determines whether a woman’s performance in labor is successful, not the patient. They have perfected delaying tactics (“You don’t really need it.””You’re doing great.” “You’re almost there.”), shaming tactics, and don’t hesitate to resort to simple obstruction by refusing to call for an anesthesiologist when the patient requests it.

Such paternalism isn’t merely unacceptable, it can be deadly as the UK experience with the Campaign for Normal Birth has shown. Scores of babies and mothers have died because midwives, in their belief that they knew best, refused to employ interventions to prevent or treat complications and refused to consult with the medical specialists who could have saved lives.

WEIRD women have moralized their ideology so that they can label those who have C-sections or formula feed by choice as selfish, lazy, ignorant and duped by culture or corporations.

This type of thinking has reached its apogee in lactivist memes such as this one:

If you don’t breastfeed you’re a selfish cunt.

Although the meme is crude, the sentiment at it’s heart is all too common. WEIRD women want to believe they are superior mothers. They wish to believe they are models that other women should emulate. And they need to believe that they set the standard to which other women not merely should aspire, but should be forced to aspire.

But WEIRD women aren’t a standard, not even for other WEIRD women; they’re just a particular cultural group whose views are not superior than the views of those who believe differently.

There’s nothing wrong with being WEIRD, of course, but there’s something very wrong with the conviction that being WEIRD means your views should be promoted by medical systems, governments and international health organizations. WEIRD women have hijacked childbirth and breastfeeding and we need to take it back from them.

Ideas have consequences.

Bad ideas about childbirth have deadly consequences.

That’s the take home message from the shuttering of the UK Campaign for Normal Birth. Midwives promoted process (normal birth) over outcome (healthy babies and mothers) and, inevitably, babies and mothers died.

It wasn’t always this way. There was a time when midwives were guardians of safety.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Midwives never intended for anyone to die, but deaths became acceptable collateral damage.[/pullquote]

Midwifery is often referrred to as the “second oldest profession.” Ever since our ancestors acquired the ability to walk upright, human childbirth has been fraught with extreme risk to both mother and baby. The first midwives were those who recognized that assistance in childbirth can minimize those risks.

They understood that something as simple as massaging a woman’s uterus after childbirth could prevent life threatening hemorrhage and that different fetal positions like breech posed specific problems that could be overcome with specific maneuvers. They acquired knowledge of the pharmacologic properties of certain plants and gave extracts to women with the intention of starting labor or stopping bleeding.

Outcome, whether mothers and babies live or die, was the MOST important goal in midwifery. It isn’t the only goal, of course; safe care can and should be accompanied by compassionate, comfortable care. But it was the sine qua non.

Despite profound changes in the human condition, midwifery changed very little … until the advent of midwifery theory. That’s when midwifery became radicalized and, as a result, babies and mothers died preventable deaths that midwives could have prevented but didn’t. Don’t get me wrong: midwives never intended for anyone to die, but deaths became acceptable collateral damage in a relentless campaign to promote process over outcome and midwifery autonomy over everything.

Don’t believe me? Consider this paradigmatic academic paper Including the nonrational is sensible midwifery, by Jenny A. Parratt, and Kathleen M. Fahy. Yes, you read that right; it is an exhortation for midwives to apply the nonrational to the care of patients.

The authors attack rationality itself:

We expose the limitations of pure rationality in the context of childbirth and use the concept of safety to exemplify the limitations that pure rationality imposes. The paper draws on philosophical and spiritual theory to present an analysis of ideas about mind, body, soul and spirit… This revised conceptualisation provides a theoretical basis that allows for and promotes more possibilities and thus more holistic ways of knowing in midwifery.

Both premise and conclusion are stunning: Many principles of midwifery are not supported by science. Rather than modify midwifery to reflect scientific knowledge, scientific evidence should be abandoned in service to midwifery autonomy.

For the treatment of postpartum hemorrhage, the authors suggest:

…[W]hen a woman and midwife have agreed to use expectant management of third stage, but bleeding begins unexpectedly, the expert midwife will respond with either or both rational and nonrational ways of thinking… [T]he midwife may focus on supporting love between the woman and her baby; she may call the woman back to her body; and/or she may change to active management of third stage… Imposing a pre-agreed standard care protocol is irrational because protocols do not allow for optimal clinical decision-making which requires that we consider all relevant variables prior to making a decision. In our view all relevant variables include nonrational matters of soul and spirit.

In other words, scientific evidence mandates technological intervention to treat postpartum hemorrhage, which isn’t compatible with the privileging of process over outcome. Rather than modify midwifery practice to reflect scientific knowledge, scientific evidence should be abandoned in service to midwifery autonomy.

There is a direct line between radical midwifery theory and the deadly Campaign for Normal Birth. In a Royal College of Midwives “analysis” published about the same time, the RCM insisted:

Care based on robust evidence probably has the highest profile it has ever had within midwifery. However, if policies, protocols, guidelines and pathways of care are too rigid and are unable to be applied flexibly, then there is a risk that midwives are unable to feel empowered to practice the art of midwifery. They need to use the intuition that experience and knowledge brings, to sense when a problem may or may not be occurring.

The RCM uses an example, too. A woman whose baby was breech was encouraged by the midwife to have a vaginal birth. The lesson midwives were to take from this:

Most midwives base their antenatal care on national guidelines … and local policies. ‘Trusting your intuition’ promotes these tools to be used flexibly …The intuition that Angharad would benefit from an extra visit at home enabled her to have the space and time to make informed choices that were right for her. Angharad made a choice that did not follow the current recommendations, i.e. the ‘safest way to have a baby in the breech presentation is by elective caesarean section’.

In other words, scientific evidence indicates that technological intervention (C-section) may be safer for breech babies, but that isn’t compatible with the privileging of process over outcome. Rather than modify midwifery practice to reflect scientific knowledge, RCM encouraged midwives to ignore scientific evidence in service to midwifery autonomy.

It’s not difficult to imagine why so many babies and mothers died as a result of such “reasoning.” In nearly every case, patients died because midwives ignored scientific evidence in favor of their intuition. This is a betrayal of the fundamental ancient goal of midwifery, putting patient health at its heart, and replacing it with a radical, contemporary imperative, putting midwife control at its heart.

Why did the UK National Health Service allow this deadly, self serving ideology to flourish? NHS made a Faustian bargain with midwives in exchange for the promise of saving money; midwives are less expensive than obstetricians. But it turns out that dead and injured babies are more expensive than both.

The radicalization of midwives has turned them from life savers to purveyors of and apologists for preventable deaths. That is unethical, immoral and completely unacceptable.

Scores of babies died preventable deaths, nearly £2bn was paid out in compensation in the past year alone, and multiple investigations have put the blame squarely on the midwives’ “Campaign for Normal Birth.”

How have midwives responded?

Australian midwife Hannah Dahlen made this repugnant claim:

For all those UK midwives feeling hammered this week by Fake News remember “thinking is difficult which is why most people judge” #ENOUGH!

Not to be outdone, the utterly reprehensible Sheena Byrom piled on with this:

I see more ‘fake-news’ coming through this am about women’s bodies and birth …

Byrom included an image blaring, “yellow journalism.”

I’ve often remarked on the fact that no sooner do I write a post then its targets rush to prove my point for me. Such is the case with my recent post What the UK midwifery leadership has in common with Donald Trump: they’re bullies.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]I’d ask Dahlen and Byrom if they have any shame, but what’s the point? Anyone who dismisses dead babies as “fake-news” is beyond reasoned argument.[/pullquote]

I wrote that UK Midwives, forced to shutter their Campaign for Normal Birth, were copying our execrable president in the following ways:

• Although they purport to care about the people they are supposed to serve, they care only about themselves.
• They smash things up, refuse to accept responsibility, then blame everyone else for their own failings.
• They exist in a bubble, surrounded by sycophants, banning anyone who disagrees.
• They are bullies.

In the wake of multiple preventable infant and maternal deaths, multiple investigations ascribing them to midwives’ insistence on privileging the process of birth (“normal” birth) above the outcome (healthy babies and mothers), and skyrocketing liability claims and payouts approaching £2bn in the past year, UK midwives have demonstrated no interest in those preventable deaths, refuse to accept responsilbity, hide away on Twitter where they endlessly praise themselves, and continue to bully anyone who disagrees.

Now they are copying Trump in his insistence that any news that doesn’t make him look good is “fake news.” It’s an ugly look for him and its an even uglier look for midwives who are ethically responsible for the health and safety of the babies who died.

Dahlen and Byrom are poster children for the moral depravity and self-dealing at the heart of contemporary midwifery. I know they read what I write so I have a message for them and their colleagues:

Dead babies aren’t fake news! Desolate parents aren’t fake news. £2bn paid in compensation is not fake news. It is all tragically real and I don’t have enough epithets to fully convey my moral outrage at midwives who wish to bury dead babies twice, first by letting them die on the altar of “normal” birth and then by trying to erase the fact that they ever existed, are still loved and will forever be mourned.

It’s difficult to imagine how midwives could adopt such a tone-deaf tactic … until you consider what the Campaign for Normal Birth was really about. It was never about what was good for babies and mothers, and alays about what was good for midwives: higher employment, greater professional autonomy and the increased freedom to promote their ideology. If you observe these midwives on social media, you will see them engage in an endless round of mutual congratulations over their “success” in promoting normal birth. The dead babies are an irritating impediment to this continued “success,” so they must be dismissed as “fake.”

Social media has allowed midwives to so insulate themselves from reality that they don’t seem to have noticed that no one is supporting them besides themselves. The public has met the shuttering of the Campaign for Normal Birth with relief, writing comments and Letters to the Editor about women who felt ignored and abused in midwives’ care. The families of the babies and mothers who died preventable deaths have been eloquent in their grief. How dare Dahlen and Byrom dismiss their babies’ deaths as fake news?

Anyone with two functioning neurons knows exactly what Donald Trump means when he bleats, “Fake news!” He doesn’t mean that it is literally untrue, just that he intends to ignore it and wants his supporters to ignore it, too.

The same thing applies to midwives. They don’t mean that the dead babies are literally fake — those babies are real and really dead — just that they intend to ignore dead babies and want their supporter to ignore them, too.

It also explains why midwives have not (to my knowledge) undertaken root cause analysis of these deaths. It doesn’t matter to them why these babies and mothers died. It only matters that they are allowed to maintain autonomy and commitment to ideology.

I’d ask Dahlen and Byrom if they have any shame, but what’s the point? It’s painfully obvious that they don’t give a damn about the babies and mothers who die at the hands of midwives and care only about themselves.

Anyone who dismisses dead babies as “fake-news” is beyond reasoned argument.

Dear Ms. Gates,

I hope I can take a moment of your time to talk about an issue that it is dear to both our hearts, albeit for different reasons.

You’re a mother of three children; I’m a mother of four. You breastfed your children; I breastfed mine. You promote breastfeeding worldwide to improve the health of babies; I’ve come to the conclusion that the aggressive, world wide promotion of breastfeeding is harming babies.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The aggressive, world wide promotion of breastfeeding is HARMING babies.[/pullquote]

You and your husband invest in promoting breastfeeding because you believe that the scientific evidence shows it saves lives. I’d like to draw your attention to the fact that the scientific evidence is weak, conflicting and riddled with confounders; that there’s no evidence that breastfeeding rates have any impact on infant mortality; and, most importantly, that because of aggressive promotion, women are literally breastfeeding babies to death.

You have written:

Breastfeeding is the absolute gold standard in infant nutrition. Studies suggest it prevents everything from diarrhea to pneumonia to diabetes to obesity.

But the scientific evidence shows that breastfeeding DOESN’T prevent most of those things.

Many breastfeeding studies do not correct for confounders. Since, as you know, breastfeeding is correlated with maternal education and economic status, most of the benefits attributed to breastfeeding are actually benefits of being wealthier and having greater access to insurance and medical care.

No less an expert than Dr. Michael Kramer of the PROBIT studies that established that breastfeeding prevents colds and diarrheal illnesses has acknowledged that breastfeeding benefits have been grossly exaggerated. In an interview on Canadian radio he was emphatic that breastfeeding does NOT prevent obesity, does NOT prevent allergies, and does NOT prevent asthma.

When asked why lactivist organizations continue to insist on benefits that have been shown not to exist, he explains that these organizations rely upon preliminary data and simply refuse to accept anything that contradicts it. He is quite blunt that lactivist organizations won’t accept scientific evidence that doesn’t comport with what they believe and he worries that their insistence of exaggerating benefits will undermine women’s trust in healthcare providers.

I’m hoping that when apprised of this, you’ll go back to your experts and ask them for hard evidence that breastfeeding is really the miracle elixir they claim. They won’t have it.

Breastfeeding rates have no impact on infant mortality rates.*

I realize that’s not what you have been told, but what you’ve been told isn’t true. Studies that claim to show that breastfeeding saves lives (including the highly influential studies in the The Lancet) are based on mathematical models and extrapolations of small studies that assume that correlation is causation. But that’s not what happens in the real world. In other words, while breastfeeding saves lives in theory, it doesn’t do so in practice.

We know this from population data in both industrialized countries and the developing world. In the US, breastfeeding rates have varied widely in the past 100 years, starting at over 80%, dropping to a nadir of 24% in 1973 and rising again to rates to over 76%. At no time during those 100 years have breastfeeding rates had any impact on infant mortality rates, which dropped steadily throughout.

Both in the industrialized world and the developing world, countries with the highest breastfeeding rates tend to have the highest infant mortality rates and countries with the lowest breastfeeding rates have the lowest infant mortality rates.

During World Breastfeeding Week you posted the following on Twitter:

You noted that between 2009 and 2014 breastfeeding rates tripled to 57% in Vietnam, soared to more than 80% in Bangladesh and increased to more than 80% in Ethiopia. But what happened to infant mortality rates in response?

As far as I can determine, the change in breastfeeding rates had no impact in the trajectory of infant mortality rates. Perhaps you can ask your experts why, if breastfeeding purportedly saves lives, it hasn’t made any difference in those countries.

As a result of aggressive breastfeeding promotion, we are literally breastfeeding babies to death.

The Baby Friendly Hospital Initiative was implemented around the globe without any evidence that it increases breastfeeding rates. The Ten Steps of the initiative directly violate both scientific evidence and medical ethics. There is no evidence that locking up formula improves breastfeeding rates; there is no evidence that banning supplementation improves breastfeeding rates (and there is evidence that supplementation increases breastfeeding rates); there’s no evidence to justify banning pacifiers and considerable evidence that pacifiers reduce the risk of sudden infant death syndrome (SIDS); and it is deeply unethical to restrict what providers can say when counseling patients about infant feeding.

Worst of all, there’s a growing body of evidence that aggressive breastfeeding promotion is leading to brain injuries and deaths of infants from hypoglycemia, jaundice, dehydration, starvation and infants falling from or being smothered in their mothers’ hospital beds because well baby nurseries have been closed. It’s such a significant problem that 3 major papers have been published on the issue in the past year alone:

• The revised United States Preventive Services Task Force (USPSTF) guidelines
• Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms
• Unintended Consequences of Current Breastfeeding Initiatives

In the developing world infants are literally starving to death because the WHO and UNICEF refuse to provide formula for them. As Gayle Tzemach Lemmon, senior fellow at the Council on Foreign Relations, wrote on CNN: Don’t make babies rely on breast milk in war zones. Babies in Iraq are starving to death even though they could easily be saved:

The surprising thing is that Lannaud and his colleagues at [Doctors Without Borders] didn’t place the blame for these underfed little ones just on war and the fact that the city was under siege. They also put the blame on other international organizations and policies that seek to do good.

“It isn’t a problem of access to food. The malnutrition we see here is primarily due to the scarcity of infant formula,” Lannaud wrote. “International organizations like UNICEF and the World Health Organization (WHO) promote breastfeeding … and provide infant formula, but only by prescription. We believe that distributing infant formula in a conflict situation like Iraq is the only way to avoid children having to be hospitalized for malnutrition.”

This is phenomenon known as white hat bias:

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

Babies are dying because the WHO and UNICEF are fired by righteous anger against formula manufacturers and their tactics of 50 years ago. But surely those charged with saving infant lives wouldn’t let them die just because they hate formula manufacturers? Actually they would.

In a remarkably tone deaf press release, Nurture Project International, “an international NGO providing technical lactation and nutrition support in Northern Iraq” insists:

Expertise, not milk powder, is the key to saving Mosul’s babies …

But babies cannot eat expertise; they need formula. A war zone is no place for ideologues who value process over outcome.

I’m writing to you, Ms. Gates, because you are deeply influential and profoundly committed to infant health. Breastfeeding, while a good thing, is not a magic, lifesaving elixir and those who claim otherwise have misled you.

I implore you to go back to your experts and ask them to address the fact that while there is no real world evidence to show that breastfeeding saves lives, there is considerable real world evidence that aggressive, unreasoning promotion of breastfeeding is killing babies.

Babies everywhere are depending on you.

 

*The major exception is the case of extremely premature infants where breastmilk lowers the risk of necrotizing enterocolitis, a deadly complication of prematurity.

Over the last few days British newspapers have been filled with articles about Royal College of Midwives shuttering their “Campaign for Normal Birth.”

One of the best appeared yesterday in the The Guardian.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]They smash things up, refuse to accept responsibility, then blame everyone else for their own failings.[/pullquote]

The announcement by the Royal College of Midwives (RCM) on Saturday that it will finally abandon its “normal birth” campaign is overdue but welcome. By promoting “normal” over medical births, the campaign has for too long dangerously implied that a non-medical birth is superior to one in which doctors are involved. Given that we have had firm evidence for more than two years that, in the very worst cases, normal birth ideology has contributed to the tragic and unnecessary deaths of women and babies, the only question is why it has taken the RCM so long to act.

As the piece notes ominously, the RCM leadership, while technically dismantling the campaign, appears to have no intention of stopping it.

Even as it ends the campaign, its chief executive has denied there may be a link between it and the sort of dangerous practice seen in Morecambe Bay. One of its honorary fellows has announced she will launch her own “normal birth” campaign as a response to the RCM moving away from this language.

They are right to worry. In my interactions with the midwifery leadership and their supporters on social media, I’ve seen no evidence that they have learned a single thing. They deny responsibility, refuse to mention let alone apologize for the countless preventable deaths at their hands, and engage in never ending congratulations of themselves and each other for their purported selflessness and commitment to women’s rights and desires.

They remind me of nothing so much as our execrable president Donald Trump. And although they aren’t leaders of the free world, they have the power of life and death over many people.

When I talk about the midwifery leadership, I want to be clear about who I mean. I’m talking about Cathy Warwick, the former head of the RCM, Sheena Byrom, often its public face, Lesley Page, the current head, premier midwifery apologist Milli Hill of the Positive Birth Movement, Soo Downe, Laura Godfrey-Isaacs and the fawning coterie with which they surround themselves.

How is the RCM leadership like Donald Trump?

Let me count they ways.

1. Although they purport to care about the people they are supposed to serve, they care only about themselves.

As I noted many times in the past, I am a cynical person. I’ve worked in the highest reaches of clinical medicine, and I’ve met a lot of people whose egos could barely fit into a conference room, but I’ve never seen such blatant self dealing and disregard for patients as I’ve observed in the UK midwifery leadership. Babies and mothers are dead. Multiple investigative panels have concluded they are the cause, yet they don’t have an ounce of shame.

Just like Donald Trump. Trump epitomizes self-dealing corruption. He apparently views the presidency as an opportunity to enrich himself. He demonstrates blatant unconcern for those he is supposed to protect and serve.

2. They smash things up, refuse to accept responsibility, then blame everyone else for their own failings.

Trump is legendary for his refusal to acknowledge his own failings, but the UK midwifery leadership is giving him a run for the money. They brazenly ignore the growing pile of tiny dead bodies (and large dead bodies of mothers, too). They literally ignore them. They don’t mention them, don’t acknowledge them, don’t accept responsibility for deaths at their hands. Despite official reports — which the RCM does not deny — that maternity negligence claims have soared and liability payments have rocketed to over £1 billion, they insist these reports are the products of their enemies, or worse. Trump claims that reports of his failings are “fake news.” UK midwives go farther, refusing to accept or acknowledge that they are news at all.

3. They exist in a bubble, surrounded by sycophants, banning anyone who disagrees.

Twitter is the Fox News of UK midwives. It allows UK midwives to recuse themselves from reality and reward themselves with a never ending round of self-congratulation. That rewarding feedback loop is infinitely more gratifying than facing the injuries and deaths that occur because of UK midwives overweening self-regard. Twitter allows them to customize their surroundings by blocking anyone who might intrude (laypeople and professionals) with distressing stories of babies and mothers who were injured or died because of midwives’ unethical promotion of “normal birth.”

Don’t believe me? Check out the Twitter feeds of Sheena Byrom and Cathy Warwick on any day. You will rarely find any mention of the preventable deaths that flood the mainstream media (except to excuse them). Instead you will be treated to a fantasy world where midwives proverbially kiss and congratulate each other over and over and over again.

4. They are bullies. Trump’s preferred method of dealing with those who disagree with him is to sue them. He is prepared to rack up enormous legal bills in the hope that his opponents will not have the financial wherewithal to keep up. One of the reasons he’s floundering so badly in the Presidency is that you can’t sue your political opponents.

UK midwives don’t have the financial resources that Trump has, but they use what they’ve got. Their treatment of loss father James Titcombe has been particularly egregious. They’ve harassed him and continue to harass him on social media, reported him to his employer and spent literally hundreds of thousands of pounds on lawyers to keep him from getting accurate records of the negligent midwifery care that killed his son.

James has been extraordinarily gracious in the face of abuse. In addition, he has cautioned me both publicly and privately to avoid attacks on specific UK midwives. He’s a far nicer person than I am. Moreover, I’m beyond the ability of UK midwives to intimidate, harass or report me. They literally cannot bully me, no matter how hard they try. And the fact that they try is emblematic of the moral rot at the heart of UK midwifery.

This morning James wrote on Twitter:

Best to avoid personal attacks (on both sides of the debate) – they don’t help.

I have to disagree with James. I suspect that publicly naming and shaming those who allow babies to die on the altar of normal birth, refuse to accept responsibility, and bully anyone who disagrees might be the only way to hold these women to account.

As the political philosopher Edmund Burke famously said:

The only thing necessary for the triumph of evil is for good men to do nothing.

That’s true about Trump and it’s true about UK midwives. Both cause suffering, both are bullies and both must be stopped.

Promoting normal birth is always and only about promoting midwives.

Many years ago, when I first heard the phrase “promoting normal birth” I was confused. Why would a healthcare professional be promoting any set of procedures or any particular approach to a health issue?

You won’t find any real medical professional who insists that he or she “promotes” one treatment over another. An ethical medical professional recommends whatever is safest for the patient, not whatever is most lucrative. Ethical medical professionals promote health and promote safety, not the opportunity to line one’s pockets.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The endless efforts of UK midwives to promote themselves have culminated in reflexive defensiveness and stone cold heartlessness in response to the cries of bereaved mothers and fathers.[/pullquote]

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. “Normal birth” and “midwives” are interchangeable. “Normal birth” is nothing more than a marketing term.

Once you realize that, it is a lot easier to understand the Campaign:

The RCM Campaign for Normal Birth (Campaign for Midwives) declared that “promoting normal birth key to cost savings” (Promoting midwives a key to cost savings.) That’s especially ironic in light of what actually happened: the number of preventable injuries and deaths soared and liability payments skyrocketed. The NHS paid £1.2 billion last year alone!

You can look high and you can look low, but wherever you look, midwives or their advocates are behind every attempt to promote “normal birth” (i.e. market midwifery). Indeed, the leading textbook of the radical midwifery theorists is Promoting Normal Birth – Research, Reflections and Guidelines best understood as Promoting Midwives – Research, Reflections and Guidelines.

The editor Sylvie Donna has the grace to be abashed at the use of the word “promoting.” She starts the introduction with the following:

You may have wondered, on first seeing this book, why the title includes the word ‘promoting.’ Why should normal birth be promoted particularly? The answer is simple. Other forms of birth — those involving plenty of interventions, especially cesareans — get plenty of promotion, simply because they may appear to be the easiest option for caregivers or the least frightening ones for pregnant women…

Even on its face, it’s a pretty inane explanation, but it is far worse when you substitute what is really meant:

You may have wondered, on first seeing this book, why the title includes the word ‘promoting.’ Why should midwives be promoted particularly? The answer is simple. Other forms of birth — those involving plenty of interventions (most of which midwives cannot do), especially cesareans (which midwives definitely cannot do) — get plenty of promotion, simply because they may appear to be the easiest option for caregivers or the least frightening ones for pregnant women… not to mention the safest and the most highly desired by mothers.

Promoting normal birth is about one thing, and one thing only: promoting midwives. It has nothing to do with what is safest. The words safe or safety don’t even appear in the entire introduction to the midwifery textbook, which is fitting since safety is entirely irrelevant to the project of promoting midwives. As far as I can tell, using Google to search inside the book, the word safety doesn’t even appear until page 177 and then only to be used pejoratively (“An obsession with safety is characteristic of our age …”).

Insisting that women be cared for by midwives because midwives want employment and professional autonomy isn’t particularly persuasive. Insisting that women be cared for by midwives because only they can provide them with a “normal” birth (who wants an abnormal birth?) sounds a lot better. The key, of course, is to invest “normal” birth with a cachet beyond the word normal. That’s where all the stuff about birth warriors, empowerment and experience comes in.

Most women don’t fall for it. British women resent the fact that access to obstetricians is severely curtailed. They despise the fact that such practices have led to preventable injuries and deaths of babies and mothers. They are not alone. Dutch women go to other countries to give birth rather than settle for the midwife led care (and higher perinatal mortality rate) that is a feature of the Netherlands. The high mortality rate has led to a precipitous drop in homebirth, now down to only 13%. And the majority of American women, regardless of the availability of midwives, choose obstetricians. Indeed, there are not enough practicing obstetricians to accommodate all the patients who want them.

The fact that normal birth is a marketing term to promote midwives also explains the reflexive defensiveness of the RCM and their stone cold heartlessness in response to the cries of bereaved mothers and fathers.

As the Guardian notes:

The response of many in the midwifery profession has been characterised by defensiveness, rather than an open commitment to finding how far this problem goes and rooting out dangerous practice. The Nursing and Midwifery Council, responsible for regulating midwives, spent £240,000 on getting lawyers to redact information in response to a freedom of information request from Titcombe.

That is startlingly unethical behavior.

Even as it ends the campaign, its chief executive has denied there may be a link between it and the sort of dangerous practice seen in Morecambe Bay. One of its honorary fellows [Sheena Byrom] has announced she will launch her own “normal birth” campaign as a response to the RCM moving away from this language.

Regardless of who is injured, how many babies die, and how many mothers are left with empty arms, UK midwives will persist in promoting themselves. It’s hard to imagine anything more morally repugnant.

It’s tremendous vindication of everything I’ve been writing for years, but tragically it has come too late for countless babies, mothers and families.

The Royal College of Midwives has finally, FINALLY, been forced to end its Campaign for Normal Birth in abject failure. Oh, they successfully promoted “normal birth” alright. But they repeatedly sacrificed the lives of babies and mothers on the altar of unmedicated vaginal birth. British health authorities ultimately called a halt to the madness.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Morally bankrupt, blood drenched midwifery leaders, like RCM head Cathy Warwick and midwife Sheena Byrom, never cared about dead babies and I suspect they still don’t give a damn.[/pullquote]

As Clare Wilson, writing in The New Scientist, explains in Why Midwives are back-pedaling on natural childbirth:

In May, the UK’s Royal College of Midwives (RCM) quietly cancelled a long-standing campaign to promote natural births. Separately, doctors are beginning their own more proactive approach to ensuring interventions happen as soon as they are needed. And campaigners have formed a new pressure group called “Maternity Outcomes Matter” to ensure all healthcare staff prioritise safety over the process of childbirth.

What happened?

While it is sensible to avoid medical interference where possible, take this approach too far and childbirth becomes more dangerous, leading to brain-damaged babies and avoidable deaths.

Some of these occurred when women were denied caesarean sections even after begging for them.

It’s not as though these tragedies weren’t completely foreseeable. I first wrote about the Campaign’s death toll in October 2011 (Promoting normal birth is killing babies and mothers):

For years, the Royal College of Midwives in the UK has been on a relentless campaign to promote “normal birth.” We are now seeing the results, and they are nothing short of horrific.

Last month the focus was on Furness General Hospital in Cumbria where 6 babies and 2 mothers have died preventable deaths …

Lest anyone is tempted to conclude that this is a problem restricted to a single hospital, today’s newspaper reports demolish such wishful thinking…

Four women and seven newborns are believed to have died in the last 12 months on labour wards at the [Essex] trust’s hospitals.

But the RCM continued to promote their deadly ideology and babies continued to die.

In 2012 I reported on the financial consequences:

The 5.5 million babies born in England between 1 April 2000 to 31 March 2010, resulted in 5,087 maternity claims, involving payouts of £3.1bn, including legal fees…

The most frequent mistakes cited in claims involved management of labour including failure to recognise the baby was in distress from fetal heart monitoring equipment or delay in acting; caesarean section including mistakes and delays and cerebral palsy, where the baby is starved of oxygen at birth and sustains brain damage, often requiring life-long care…

The report said: “Unfortunately, many of the same errors are still being repeated.”

But the RCM continued to promote their deadly ideology and babies continued to die.

In 2015, the Kirkup report on the deaths more than a dozen babies and mothers at at Morecambe Bay was issued and it was a catalog of horrors.

Referring to the 5 deaths in 2008 alone, the report noted:

All showed evidence of the same problems of poor clinical competence, insufficient recognition of risk, inappropriate pursuit of normal childbirth and failures of team-working…

The midwives at Furness general were so cavalier they became known as “the musketeers”.

But the RCM continued to promote their deadly ideology and babies continued to die.

A different report published later in the year highlighted the fact that NHS errors leave 1,300 babies dead or maimed.

The NHS paid or set aside just under £1 billion [$1.5 billion] last year to settle 1,316 claims of negligence in maternity units, up from £488 million a decade ago, data from the NHS Litigation Authority show. The most costly claims involve babies brain-damaged during labour, who will require constant care for the rest of their lives.

One basic error accounts for a quarter of payouts, with campaigners saying it was a “scandal” that the health service was failing to learn from its mistakes. They blamed divisions between midwives and doctors, saying that the desire for “natural” births — without interventions — sometimes went too far…

But the RCM continued to promote their deadly ideology and babies continued to die.

And the financial costs continued to rise.

In May of this year The Guardian described a new report on liability:

The number of claims for brain damage and cerebral palsy has tripled in a decade, amid widespread monitoring failures…

… Since 2004/5, the value of claims against NHS maternity units for brain damage and cerebral palsy has risen from £354m to £990m, official figures show.

The cases – often linked with a failure to monitor babies’ heart rates, to detect risks of oxygen starvation – fuelled maternity negligence claims of more than £1.2bn in 2015/16 [$1.5 billion].

I asked at that time: how many babies have to die and how many billions of pounds have to be paid out before the morally repugnant, incompetently trained, self-dealing, deadly UK midwives are held to account?

That liability report appears to have been a tipping point. That was when the Campaign to Promote Normal Birth was quietly shuttered. The fact that the RCM has been silent suggests they hadn’t learned a damn thing and were pressured by higher authorities.

As Wilson notes in her New Scientist piece:

Thankfully, the bad RCM advice has now been taken down, although it’s a shame the midwives’ leaders have tried to do this quietly…

Back-pedalling on the quiet means news will spread more slowly to grassroots midwives and schools of midwifery. There is great variation in practice, and while there are many excellent midwives who prioritise safety, there are also those who may resist change.

If the RCM genuinely wants to reduce avoidable bereavements, it should shout about its change of heart from the rooftops. Most people think of medicine as a field where decisions are guided by evidence rather than ideology. That should be true for childbirth too.

I doubt the RCM has had a change of heart. Their morally bankrupt, blood drenched leaders, especially RCM head Cathy Warwick and midwife Sheila Byrom, have never cared about dead babies and dead mothers in the past and I suspect they couldn’t care less now, either.

The Campaign for Normal Birth was always at heart a campaign to benefit midwives, babies and mothers be damned. It was always about full employment, higher salaries and greater professional autonomy for midwives. If countless babies and mothers had to die to achieve that, Cathy Warwick, Sheena Byrom and the Royal College of Midwives were willing to let them pay the price.

Imagine reading about a baby desperately injured after being ejected through the windshield when her mother’s car was hit. Imagine that the mother had failed to buckle the child into a car seat because she didn’t “believe in them” for short trips like the one she was taking to the grocery store. Now imagine that the mother insisted that doctors told her her baby’s serious brain injury had nothing to do with choosing to forgo a car seat.

Yeah, I wouldn’t believe her either.

That’s the reaction I have to the latest story of a child grievously injured by homebirth. I don’t have to look for these stories; as homebirth has become more popular, they’re all over various  health communication and crowd funding sites (when parents are trying to raise money to cover hospital expenses or funeral expenses or both).

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]If the mother had given birth in a hospital instead of at home, the baby almost certainly would not have sustained a devastating brain injury.[/pullquote]

This mother’s chief impulse seems to be to avoid accountability.* On the CaringBridge site she writes:

Due to several factors involved at the time of her birth (but not related to the birth itself), M was born not breathing and unresponsive.

She reiterates the same claim when telling the birth story on the “Awesome” HBAC [Homebirth after Cesarean] Facebook group:

Finally going to share my story, but before I do I must make it known that doctors have all agreed that baby’s birth in and of itself played no part in the trauma that followed.

That’s absurd.

Before we delve into what happened, let’s review how giving birth outside of a hospital could be dangerous for a baby:

• The baby might be deprived of oxygen during labor.
• The baby might need an expert resuscitation with intubation immediately after birth.
• The baby might have inhaled meconium.
• The baby might be in a dangerous position like breech.
• The baby might become infected with Group B Strep, a bacteria that is particularly deadly for newborns.

What happened in this case? Everything listed above!

The mother ruptured her membranes at 2:20 AM.

At about 2:20 PM, the mother was having contractions every 6-7 minutes and noted light meconium.

At 5:30 PM, the mother noted moderate meconium.

At 8:30 PM, the midwife arrived.

At 10:30 PM, the midwife performed an exam and discovered … the baby was breech!

As 1 AM approached:

…Baby’s heart rate remained stead and strong, but meconium was super thick (as is typical with breechlings, so we had no worries… Then the strong pressure of head coming and the sudden relief of it passing thru. I did it! Another breech baby …2hba2c!

The mother is so proud of her “accomplishment,” but what about the baby?

That’s when things took a serious turn for the worst.

The baby was born unresponsive and not breathing. In other words, as in most homebirth disasters, a nearly dead baby dropped into the hands of a totally clueless midwife.

Midwife suctioned, started CPR and oxygen and best friend called 911. Midwife continued to let the cord pulse while doing those things … when the ambulance arrived they told her to do what she needs to, clamp the cord, and pass baby off. She milked every last drop of blood from that cord that she possibly could into my baby (I firmly believe that is what saved baby’s life). Cut the cord, passed baby to EMT, he ran out the door with my baby and husband, and I and my teen daughter (who had been there the entire labor and delivery with me) collapsed on the floor sobbing…

The mother noted:

Doctors feel like it was a mixture of meconium aspiration and group b strep hitting super hard that made M not breathe/repond at birth. She was without appropriate oxygen for 10 minutes.

Of course the mother had declined testing for Group B strep before birth.

The baby was born a little over 3 weeks ago. What’s her prognosis now?

… they still can’t be certain that she won’t have issues such as low muscle tone, learning delays, and they don’t know if/when she will get suck/swallow/gag.

She’s having a gastrostomy tube placed because she will be unable to eat by mouth any time soon.

Obviously this entire disaster, and the horrible brain injury that the baby suffered, are entirely due to the decision to have a homebirth. The baby was oxygen deprived during labor, aspirated meconium, and was infected by Group B strep. All of these things could have been prevented if the mother had had an elective repeat C-section.

Did any doctors really say “that baby’s birth in and of itself played no part in the trauma that followed”? I doubt it. I suspect that what they said was that the actually delivery of the breech baby was not the cause of the problems since it wasn’t. It was the undiagnosed fetal distress, meconium aspiration, Group B strep infection, and inability to provide immediate expert resuscitation that led to the baby’s brain damage … all things that could have and almost certainly would have been avoided in a hospital. If the mother had been more concerned about the baby’s health than about her “achievement,” and consented to an elective C-section, the baby would almost certainly be perfectly healthy today.

Remember the thought experiment of the baby ejected through a windshield because her mother failed to put her in a car seat? That mother could claim that it wasn’t failure to use a car seat that caused her baby’s injury; it was the fact that her baby went head first onto the pavement after being ejected through the windshield. I wouldn’t be impressed with that claim either. In both cases a baby’s brain damage is the direct result of a mother’s negligent choice … no matter how desperate this mother is to pretend otherwise.

 

*Edited to correct a very serious error on my part: CaringBridge sites are not fundraising sites. The mother is NOT try to solicit money. I regret my mistake.

 

If you want to understand the state of breastfeeding promotion in the US today, there’s no better place to start than the vast gulf between lactivists’ (“Breast Is Best”) fears and nurturists’ (“Fed Is Best”) fears.

Lactivists fear that breastfeeding won’t be supported; nurturists fear that babies won’t be supported.

There is something very, very wrong about valuing a process more than an outcome. Sure lactivists insist that breastfeeding promotes optimal outcomes, but the outcomes themselves show that this isn’t true.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactivists fear being shamed for public breastfeeding; Fed Is Best advocates fear their babies’ deaths![/pullquote]

Lactivists fear that information about risks will discourage breastfeeding; nurturists fear that suppressing information about risks will discourage safety.

Lactivists fear that hypoglycemic, jaundiced or dehydrated infants infants might get formula; nurturists fear that hypoglycemic, jaundiced or dehydrated infants might get brain injuries.

Lactivists fear breastfeeding won’t be normalized; nurturists fear their babies won’t be normal.

Lactivists fear being shamed for public breastfeeding; nurturists fear their babies’ deaths.

That’s right; lactivism is literally killing babies. And it’s doing so in a variety of ways:

• Refusal to acknowledge that insufficient breastmilk is common, not rare
• Refusal to supplement babies who are hypoglycemic, severely jaundiced and dehydrated
• Promoting unsafe sleeping practices by leaving babies in bed with mothers who are exhausted, sedated and surrounded by soft bedding
• Closing newborn nurseries thereby preventing exhausted, sedated mothers from getting the sleep they need

We’ve all heard about baby Landon Johnson who had a cardiopulmonary arrest due to dehydration less than 12 hours after being sent home from the hospital where his mother was repeatedly assured by lactation consultants that he was getting enough breastmilk.

Now comes word of another perverse and heartbreaking tragedy. A mother is suing an Oregon hospital because her newborn suffocated to death in her hospital bed.

According to the Oregonian, Mom who accidentally suffocated newborn in hospital bed sues for $8.6 million:

A new mother who accidentally smothered her 4-day-old baby in a hospital bed has filed an $8.6 million lawsuit against Portland Adventist Medical Center.

Monica Thompson faults the Southeast Portland hospital for putting her newborn, Jacob, in bed with her in middle of the night so she could breastfeed him while she was unsupervised and heavily medicated with painkillers and sleep aids.

Thompson dozed off, then awoke to find that Jacob wasn’t breathing on Aug. 6, 2012, according to the lawsuit filed last week in Multnomah County Circuit Court.

Jacob suffered catastrophic brain damage, and his parents removed him from life support six days later after doctors told them that his comatose state was irreversible.

It’s an unspeakable tragedy because a new mother lost her healthy firstborn child to a cause that was easily preventable; it’s perverse because Jacob died as the result of the hospital’s efforts to meet the requirements of the Baby Friendly Hospital Iniatiative (BFHI), a program to promote breastfeeding because of its purported health benefits.

It really ought to be called the Baby Deadly Hospital Iniative because its major tenets are incompatible with safe infant care. These include censoring healthcare providers so they cannot provide accurate information about the risks of breastfeeding; banning formula supplementation; and closing well baby nurseries. The BFHI also bans pacifiers despite copious evidence that they reduce the risk of sudden infant death syndrome (SIDS).

Breastfeeding promotion has been causing so many injuries and deaths that the American Academy of Pediatrics has published several papers on these tragedies. The latest evidence includes:

• The revised United States Preventive Services Task Force (USPSTF) guidelines
• Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms
• Unintended Consequences of Current Breastfeeding Initiatives

Together these papers show that the BFHI doesn’t increase breastfeeding rates, ignores the scientific evidence on pacifiers, formula supplementation, and Sudden Infant Death Syndrome (SIDS) and leads to preventable infant injuries deaths when babies fall from or get smothered in their mothers’ hospital beds.

The bottom line is that the fears of lactivists are incommensurate with the fears of Fed Is Best advocates.

Lactivists are primarily concerned with their feelings — being able to breastfeed in public without censure, getting support for breastfeeding difficulties, improving their self esteem by feeling they are doing something important for their babies. Don’t get me wrong; those are fine goals and I strongly advocate for lactation services for those who wish to breastfeed and the right for women to breastfeed whenever and wherever their babies get hungry, BUT these fears pale into insignificance next to women’s fears that their babies will die due to insufficient breastmilk, smothering and falling from hospital beds.

It’s long past time to abolish the Baby Friendly Hospital Initiative. There is precious little evidence that breastfeeding saves the lives of term babies and a growing body of evidence that we are breastfeeding babies to death instead.

Dear Ms. Williams,

I was shocked to read that you — a feminist icon — have fallen prey to sexism.

Speaking about the impending birth of your first child, you told Herald Sun’s Stellar:

I am about to be a real woman now, you know? It’s going to be something incredibly impressive to go through.

Of course, the backlash has been swift and predictable, pointing out that many women don’t want or can’t have children and they are real women, too.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Sadly, you are promoting the sexist view that women are only “real” and valuable if they are using their reproductive organs.[/pullquote]

I suspect that you know that and never meant to imply otherwise, but the real problem with your statement is not that it is disrespectful to childless women (though it is). The real problem is that it is deeply retrograde and anti-feminist.

For most of human history, women were reduced to their reproductive organs — breasts, uterus and vagina. Their brains, their talents and the contents of their characters were deemed irrelevant or worse: unwomanly. Women were expected to seek fulfillment in mothering; until that day they were expected to keep themselves busy with “womanly arts” like needlework. Intellectual efforts, artistic endeavors and, obviously, physical competition in athletic pursuits weren’t merely off limits; they were considered “mannish.”

By implying that you aren’t yet a real woman, despite being a powerful, talented, brilliant and obviously womanly woman, you are reverting to the sexist view that women are only “real” and valuable if they are using their reproductive organs. It is an insidious form of sexism, but one that has become increasingly popular since the advent of the legal, political and economic emancipation of women. It is insisidous because it dresses up sexism as praise; but it is no less sexist than judging women by the size of their breasts instead of the size of their accomplishments.

As someone who has given birth to four children and raised them to adulthood I feel qualified to tell you what giving birth will and won’t do for you.

Childbirth WILL make you a mother.

Here’s a few other things childbirth will make you:

A woman with a torn vagina, leaking from just about every orifice, in pain and hoping that none of the changes are permanent. No glamor here!

It is no more impressive than being able to breathe, digest food or walk; pretty much any woman can do it. In contrast, no one can play tennis like you can.

It’s not empowering. Here’s a little tip: If it doesn’t empower a 15 year old Afghan girl giving birth in a hut in agony and at high risk of death due to lack of medical care, it’s not going to empower you.

It’s a process, not an outcome and it is the outcome of childbirth — a new, unique human being — that will change your life in ways that you haven’t even dreamed about.

Until you have a child, you have no idea what the love of a mother for her child really means. You think you are fierce now; wait until someone poses a threat to your child; you’d battle a wild animal with your bare hands and no hesitation.

Until you have a child, you have no idea what the fear of a mother for her child’s wellbeing really means. I guarantee you will obsessively check your sleeping child to be sure that he or she is still breathing. Even the idea of losing that child will be shattering and unfathomable.

Until you have a child, you have no idea what mothers are willing to sacrifice to improve their children’s lives; you have no idea how much more painful your child’s disappointments will be than yours ever were or how sweet your children’s smallest accomplishments will be even compared to your greatest accomplishments.

Until you have a child, you have no idea what unselfish love means. Finding out will be one of the greatest joys of your life.

Being a woman makes it possible to have children, but it’s hardly the only way. Don’t imagine that mothers who adopt are lesser women because they didn’t give birth. Honestly, one thing has nothing to do with another beyond basic biology and even then you have it exactly backwards; being a woman makes it possible to give birth; giving birth doesn’t make it possible to be a woman.

In truth, childbirth will make you something you have never been before, a mother; but you’ve been a real woman all along.