I’ve been blogging for over a decade now, but it’s only been in recent months that I’ve started writing political posts.

Not surprisingly regular readers who are Trump fans are wondering why.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Homebirth midwives are buffoons. Donald Trump is King of Buffoons.[/pullquote]

First and foremost, it’s because I love my country. America has made terrible mistakes in its past, but I still view it as a shining city on the hill, a beacon of hope to lovers of freedom everywhere. Trump threatens my beloved country and it seems to me that patriotism obliges me to speak out.

Second, I am profoundly distressed by what I am witnessing and I seek the solace and counsel of people I respect a great deal: my readers. I have the greatest group of commentors on the internet, smart, passionate, and articulate. Sure I offer my view on my blog, but I learn from my readers and modify my views accordingly.

Ultimately, though, I’ve started writing about politics because I’m a skeptic. My self-appointed task is to debunk harmful lies designed to mislead people and profit from their distress, and Trumpworld, like the natural parenting world, is nothing if not a philosophy built on harmful lies designed to mislead people and profit from their distress.

1. Both the birth world and Trumpworld rest on a foundation of lies.

Contrary to Grantly Dick-Read’s claim, primitive women don’t have painless labors and labor pain is not caused by fear. Contrary to lactivist claims, breast is not best for every baby. Contrary to attachment parenting advocates’ claims, infant attachment requires only the “good enough mother” not the always physically proximate mother. Contrary to anti-vax claims, vaccines don’t cause autism and are one of the greatest public health advancements of all time.

Similarly, contrary to Trump’s claims, the disappearance of blue collar jobs has nothing to do with Mexicans and Muslims, and everything to do with global forces and technological advancement. Contrary to Trump’s claims, the problems we face in 2016 are complicated not simple, so simple solutions that can be encapsulated in a tweet will not work. Contrary to Trump’s claims that liberal elites have broken our country, the truth is conservative elites have broken our country in order to create chaos. The world as portrayed by Fox News and Breitbart is no more accurate than the world as portrayed by health conspiracy theorists.

2. Both the birth world and Trump world are built on regressive philosophies.

The natural parenting world reflects the effort, both open and clandestine, to force women back into the home. Natural parenting advocates speak to mothering anxieties, offer rigid prescriptions and not coincidentally enjoin women from engaging in the wider world of intellectual, economic and political pursuits. Trumpworld reflects the effort on the part of conservatives to hoard power for their own benefit, not for the benefits of voters. If you didn’t believe that before, you have to be figuratively blind not to realize it now.

The transition to Trumpworld is barely over a week old and it is already debasing the presidency. As Republican security expert Elliot A. Cohen writes in today’s Washington Post:

The president-elect is surrounding himself with mediocrities whose chief qualification seems to be unquestioning loyalty. He gets credit for becoming a statesman when he says something any newly elected president might say (“I very much look forward to dealing with the president in the future”) — and then reverts to tweeting against demonstrators and the New York Times. By all accounts, his ignorance, and that of his entourage, about the executive branch is fathomless. It’s not even clear that he accepts that he should live in the White House rather than in his gilt-smeared penthouse in New York.

Trump promised to drain the swamp, instead he is already wallowing in it.

3. Both the birth world and Trumpworld are built on ignorance.

Just as American homebirth midwives are the least educated, least trained midwives in the world, Trump has no education or training in government. In both cases, their followers don’t seem to mind since the entire purpose of hiring them is to spit in the face of traditional authority. Precisely because of their ignorance and lack of training, homebirth midwives have appalling rates of neonatal death and injury. Precisely because of his ignorance, Trump is likely to have appalling political, social and economic outcomes. Homebirth midwives are buffoons. Donald Trump is King of Buffoons.

4. Both the birth world and Trumpworld exploit distress without relieving it.

Natural parenting and anti-vax are, in part, reactions to the coldness of contemporary medical practice. People are seeking providers who listen to them and comfort them even if that means offering delusions instead of science. Blue collar workers are reacting to economic dislocation. Traditional Republican politicians have ignored that distress while putting the needs of lobbyists above their needs. Trump listens to them and comforts them by providing delusions instead of reality.

5. Both the birth world and Trumpworld offer faux “empowerment.”

In the world of natural parenting, empowerment has nothing to do with power and everything to do with defiance. In Trump world, empowerment of his supporters has nothing to do with economic relief and everything to do with unrestricted expressions of hate toward minorities, immigrants and women.

6. Both the birth world and Trumpworld are hoaxes that redound to the economic benefit of the purveyors.

The natural parenting world has created an army of providers — homebirth midwives, doulas, lactation consultants, bloggers with supplement stores — who profit most when they exaggerate and mislead. Trumpworld is just the latest iteration of Republican strategy to arrogate power by offering constituents social crumbs like pandering on religion and permission to hate, while impoverishing their voters and scooping up financial benefits for themselves and their industry friends.

Trump is preparing to take economic betrayal to even greater heights. His administration promises to be a cesspit of corruption led by the avaricious Trump and his avaricious family. They are already debasing the presidency by advertising their businesses on transition websites. They will turn this country into a banana republic where loyalty to Trump is the only qualification for inclusion in the government and Trump enrichment will be the ultimate metric for government policy.

The bottom line is that Trumpworld has a lot in common with the birth world, and as someone who spends my time debunking the mistruths, half-truths and outright lies of the natural parenting industry, it’s only logical that I would want to debunk the mistruths, half-truths and outright lies of Trumpworld.

I generally agree with NY Times columnist Frank Bruni, but not this time.

According to Bruni, The Democrats Screwed Up.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Republicans won because they were willing to betray American law and Constitutional principles.[/pullquote]

Despite all the discussion of demographic forces that doomed the G.O.P., it will soon control the presidency as well as both chambers of Congress and two of every three governor’s offices. And that’s not just a function of James Comey, Julian Assange and misogyny. Democrats who believe so are dangerously mistaken.

Other factors conspired in the party’s debacle. One in particular haunts me. From the presidential race on down, Democrats adopted a strategy of inclusiveness that excluded a hefty share of Americans and consigned many to a “basket of deplorables” who aren’t all deplorable. Some are hurt. Some are confused.

We’re supposed to tolerate the intolerant.

Liberals miss this by being illiberal. They shame not just the racists and sexists who deserve it but all who disagree. A 64-year-old Southern woman not onboard with marriage equality finds herself characterized as a hateful boob. Never mind that Barack Obama and Hillary Clinton weren’t themselves onboard just five short years ago.

Political correctness has morphed into a moral purity that may feel exhilarating but isn’t remotely tactical. It’s a handmaiden to smugness and sanctimony, undermining its own goals.

I don’t think so.

The Republican success is undeniable but it was NOT achieved by Bruni’s strategy — understanding why the majority of the country votes Democratic or pondering Obama’s successes. That idea is ludicrous. The Republicans captured all three branches of government because they were willing to stretch American law and Constitutional principles out of all recognition.

1. They hold the House because of gerrymandering. If House seats were apportioned based on the proportion of people who vote for Democrats, it would be overwhelmingly Democratic. Gerrymandering involves carving House electoral districts to favor the party in power within a state. It is a deliberate tactic to frustrate the will of the voters and substitute the will of the political elite.

2. Gerrymandering allowed Republicans to achieved their victory by a deliberate campaign of shutting government down both literally and figuratively. Mitch McConnell and his colleagues played the long game. They gambled that by using intransigence to break the government, they could benefit from the desperation of those who perceived government as broken. They were right.

3. They achieved their victory by mobilizing the forces of hate. Anyone who thinks that hate wasn’t on the ballot is living in a dream world. Trump used hate to rile up a large segment of the population and bet that the rest were perfectly willing to live with hate, intimidation, discrimation and violence if they thought they could find economic relief.

4. They achieved their victory by lying. From the past 25 years, from Fox News to Breibart, the Republican press has engaged in a propaganda campaign that would make the Nazis proud. They learned from Hitler: if you tell a lie big enough for long enough, people will believe it.

5. They achieved their victory by criminalizing the political opposition. I suspect that when historians come to write the story of Trump’s election, they will begin not with his decision to run, but with Ken Starr’s investigation that led to Bill Clinton’s impeachment. Hillary Clinton’s loss is a direct consequence of the 25 year campaign to frustrate the electoral will of the voters by constantly prosecuting Democratic winners. The lesson they learned from the Clinton impeachment was not that prosecuting your political opponents doesn’t work (though it didn’t work that time). The lesson they took away was that they didn’t try hard enough. They spent the next 25 years spending billions investigating Hillary Clinton, finding nothing, but betting that the mere act of investigating her would cast a pall of suspicion that she would never shake.

The Republicans control all three branches of government because they were willing to ignore the Constitution and frustrate the will of the people by gerrymandering, breaking the government, mobilizing the forces of hate, telling monstrous lies and criminalizing the opposition party.

The idea that the Democratic party could have won if it had been more inclusive of the intolerant is naive in the extreme. It is the naïveté of Bruni and other liberals that has allowed this to happen, not the failure to embrace the intolerant.

Republicans made tactical decisions to put their insatiable appetite for political power ahead of the needs of the people of the United States. And it worked.

Is there any well-informed person who does not think Bill Clinton would have done more to help Americans, including those of the Republican party, if he had not been frustrated by Republican intransigence and the impeachment?

Is there any well-informed person who does not think that Barack Obama would have done more to help Americans, including those of the Republican party, if he had not been frustrated by the Republican tactical decision to break the government and thereby thwart all his efforts to improve the economic fortunes of everyone?

Is there any well-informed person who does not think that Hillary Clinton would have done more to help the intolerant than Donald Trump and the Republicans are ever going to to do?

To imagine that the election results would have been different if liberals had been more tolerant of the intolerant is quaintly and tragically liberal. It reflects a world view that we can all live in harmony if we just try harder to understand each other. And it is worse than wrong. By ignoring the massive, long-term tactical effort that the Republican’s made to capture all three branches of government we’ve missed the most important lesson: their deliberate political tactics worked.

Tolerate the intolerant? I don’t think so.

To paraphrase Bruni, tolerating the intolerant is political correctness morphed into moral purity; it may feel exhilarating but isn’t remotely tactical. Indeed, it’s the exact opposite of a winning strategy.

To win we have to fight the political tactics that have been used against us — gerrymandering, intransigence, hate, propaganda and misuse of laws — not withdraw into the liberal fantasy that all we ever need is greater sympathy and more understanding.

The central conceit of natural parenting is that it is based on science. Nothing could be further from the truth. Natural parenting does not seek validity in rationality, but rather in romanticism.

What’s the difference?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Those who do not remember the past have condemned their children to repeat its suffering and death.[/pullquote]

According to philosopher Walter Truett, there are a variety of different ways of understanding the world including:

… the scientific-rational in which truth is “found” through methodical, disciplined inquiry

in contrast to:

… the neo-romantic in which truth is found either through attaining harmony with nature and/or spiritual explorations of the inner self…

The scientific view of parenthood is reflected in modern obstetrics, pediatrics, and immunology among other fields. It is predicated on the idea that nature is amoral (“bloody in tooth and claw”), as well as the easily verifiable scientific facts that childbirth is inherently dangerous, breastfeeding has only limited benefits, and vaccines are the biggest life-savers of children.

Natural parenting is a rejection of rationality in favor of a past that never existed:

Neo-romantics reject both the postmodern and the modern, and long for a fantasizes golden era before the Industrial Revolution and the Enlightenment.

Both scientific and historical fact tell us that childbirth is dangerous, and was only made safe by technology. Romanticism fantasizes that childbirth was safe in the past, and technology has made it dangerous.

Scientific fact and historical fact tell us that exclusive breastfeeding has a high death rate that can only be prevented with infant formula. Romanticism fantasizes that breastfeeding saves lives and formula kills.

Scientific and historical fact tell us that vaccines are one of the greatest public health advancements of all time. Romanticism ignores the dead and their potential descendants and fantasizes that because survivors of infectious scourges are “still here” vaccines are unnecessary.

Why have we experience a resurgence of romanticism in the face of incontrovertible evidence that nature is often deadly?

The growth of the neo-romantic culture in recent years has been nothing short of spectacular. It obviously expresses … a deep disaffection for modern civilization… It has most of the features of earlier romanticism — the reverence for nature, the personal-development preoccupation bordering on narcissism, the mystique of the noble savage — but these appear in much updated forms: environmentalism, spirituality, movies such as Dances With Wolves.

• Hence the narcissism of promoting the mother’s birth experience above the child’s safety, the mother’s “breastfeeding journey” above the child’s health, and the narcissistic fantasy of being “educated” about vaccines.
• Hence the insistence that childbirth is traditionally deeply spiritual and labor pain has been a source of empowerment when it was never either in the past.
• Hence the veneration of “normal” birth.
• Hence the wannabe birth “goddesses” who chant affirmations and refuse medical care.
• Hence the mystical faith in breastmilk to treat and prevent every illness known.
• Hence the fantasy that native peoples eat the placenta despite the fact placentophagy was first described in California in the 1980’s.
• Hence the notion that food is “medicine” and you can “strengthen” your immune system by eating right.

Contrary to the claims of natural parenting advocates, these are not supported by scientific evidence, but rather reflect a desperate desire to romanticize the past as being somehow preferable to the technological present.

Natural parenting is firmly backward looking yet the past it looks back toward never actually existed anywhere but in the mind of natural parenting advocates. Sadly it recapitulates the past that truly did exist: preventable deaths at homebirth, babies starving due to insufficient breastmilk, children dying of infectious disease for lack of vaccination and women forced back into traditional gender roles.

Natural parenting isn’t merely unscientific; it is ahistorical.

To paraphrase George Santayana: natural parenting advocates who do not remember the past condemn their children to repeat its suffering and death.

And the ultimate irony is that they are proud of themselves for doing so.

In the aftermath of this election I am afraid of so many things.

I am afraid that my beloved country will move backwards and retreat from the vaunted American respect for minorities, immigrants, the poor and the disenfranchised.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]This election was not democracy in action; it was nascent fascism in action.[/pullquote]

I’m afraid that my country will betray its ideals and give religion a central place in a government whose founding principles included the separation of church and state.

I’m afraid that the environment will be ruined, business will run amok without regulation, and the economy will enter a severe recession or even depression.

And I’m afraid that my party, the Democratic party, will draw the wrong message from the election results.

I’ve been reading a lot about the election as a repudiation of the elites by blue collar workers. Democrats had become out of touch with the suffering of lower middle class white people, suffering that came from the same sources that powered the rise of the elites to their positions of influence and wealth. I don’t disagree with that … but I don’t believe that is why Donald Trump was elected over Hillary Clinton.

Sure, the Democrats had a flawed candidate. Hillary Clinton brought a lot of baggage into the race; she is reflexively distrusted by people who have marinated in 25 years of non-stop Republican hate and lies. And that’s before we add in the misogyny on the part of many voters … but I don’t believe that is why Donald Trump was elected over Hillary Clinton.

Sure, the Democrats had their problems including scandals with Debbie Wasserman Schultz and her replacement Donna Brazile… but I don’t believe that’s why Donald Trump was elected over Hillary Clinton.

If we blame Clinton’s loss on these factors I fear we have missed the central point about this election: only one candidate, Hillary Clinton, was running for President. Donald Trump, in contrast was running for Strongman.

Trump, a serial liar, philanderer, cheater, sexual predator and failed business man was running as a fascist and was elected precisely because he promised, as fascists always do, to make the trains run on time. He will do so, in the time honored tradition of fascists, by seizing control of government, exploiting it to enrich himself and his family, and diverting the masses by sanctioning hate against the traditionally despised.

This was an election like no other. Hillary Clinton didn’t merely face Donald Trump, she faced the combined efforts of Fox News, Breitbart, the unreasoning hatred of Republican lawmakers who have wasted millions of taxpayer dollars trying to smear her, the hacking of her campaign and the release of unflattering private emails, the technical and political might of the Russian dictator Vladimir Putin and the political bias of the FBI director who violated protocol to make egregious insinuations that he later was forced to retract.

Those forces were determined to prevent her election by means legal or illegal and they succeeded.

They wanted to elect a demagogue so they could use him to enact an agenda that is both distinctly un-American and profoundly dangerous to American interests. What is that agenda? They, from the alt-right through Putin, want to create chaos and Donald Trump is undoubtedly the chaos candidate.

This was not just another election where two parties faced off against each other. This was a unique election where one party faced off against forces of both internal and external actors who seeks to take America from a shining city on a hill to a cesspool of racism, financial turmoil and diminished international power and influence.

Trying to make sense of this campaign by casting it as the elites against the blue collar workers is not only wrong, but it blinds us to the true forces at work. It’s like blaming the accession of Hitler in Germany on the fact that the other parties didn’t have compelling candidates. Hitler didn’t come to power because of what the opposition did; he came to power because of what he did to engineer his ascent by means legal and illegal.

Trump didn’t come to power because Hillary Clinton was a flawed candidate. He has come to power because of what he and his erstwhile allies did, both legal and illegal, to engineer his victory.

And that doesn’t even take into account that the Republicans spent 8 years questioning the legitimacy of Obama’s presidency and refusing to act on his nominations and legislative priorities. The Republicans did it so they could discredit a Democratic president and keep him from helping the very people who voted for Trump. “The government is broken!” Trump voters cry and they’re right, but it was the Republicans who broke it, not the Democrats.

Trump voters claim they don’t want politics as usual; they’ve gotten their wish and I’m afraid they and the rest of us will pay dearly as a result.

We were manipulated into selecting the candidate of the KKK, the American Nazi party, and Vladimir Putin. We have elected evil; we have elected hate; we have elected dirty dealing.

So don’t tell me that Democrats could have won if we had only selected a more popular candidate. Who else but Hillary Clinton could have withstood the abuse, and the lies, and hacking of her campaign and the efforts of Vladimir Putin and still have remained standing, let alone get elected? No one.

So don’t tell me we need to heal or that we need to reach across the aisle or we need to listen to the blue collar workers.

So don’t tell me to calm down because it can’t be all that bad. When you elect an evil, hateful, double-dealing predator as Strongman, you are going to get evil and hate and double-dealing and violation of rights, and the enrichment of the Trump family and their cronies. We just have to hope against hope that we won’t get depression and war to go along with it.

And whatever you do, don’t tell me that we need to accept the results of this election because that’s how democracy works, because this election was NOT democracy in action, it was nascent fascism in action.

Recently Amber wrote on the my Facebook page:

Can you adress the issue of over-medicalized births and malpractice? You make some very strong arguments against the “natural” childbirth movement but you haven’t discussed why women are looking for new options.

Amber is asking about defensive medicine.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Defensive medicine offers real benefits to patients.[/pullquote]

According to Wikipedia:

Defensive medicine … refers to the practice of recommending a diagnostic test or treatment that is not necessarily the best option for the patient, but … to protect the physician against the patient as potential plaintiff…

Defensive medicine takes two main forms: assurance behavior and avoidance behavior. Assurance behavior involves the charging of additional, unnecessary services in order to a) reduce adverse outcomes, b) deter patients from filing medical malpractice claims, or c) provide documented evidence that the practitioner is practicing according to the standard of care, so that if, in the future, legal action is initiated, liability can be pre-empted. Avoidance behavior occurs when providers refuse to participate in high risk procedures or circumstances.

What about defensive medicine in obstetrics?

Consider the high rate of C-sections and inductions. They satisfy the requirements of assurance behavior.

Reducing adverse outcomes? Check.
Deterring medical malpractice claims? Check.
Pre-empting liability? Check.

Consider the precipitous decline in the rate of VBAC. That’s avoidance behavior: malpractice insurers have forced providers and hospitals to refuse to participate in VBACs.

There’s an important subtext that undergirds defensive medicine that often goes unrecognized and therefore unanalyzed. Defensive medicine is driven by the fact that we live in a “risk society,” a society that is organized around a new understanding of risk.

There have always been risks, of course, but they have traditionally been viewed as outside the control of human beings — the risk of a hurricane or other natural disaster for instance. The risk society has arisen because of new beliefs that we can and (especially) that we should control every aspect of risk.

In our risk society, we are obsessed with the risk of auto accidents and outfit our cars with ever more airbags and safety features. We are obsessed with risks to our children, and restrict their play outdoors and their independence, and we are obsessed with illness and death, literally passing laws to control personal habits like smoking.

How does the “risk society” impact obstetrics? We have become obsessed with the perfect child, and we construct ever more elaborate requirements to ensure that everything we do contributes to the perfect outcome.

But childbirth is inherently dangerous, especially for babies. Indeed, it has been the leading cause of death of babies, and one of the leading causes of death of young women in every time, place and culture. The most dangerous day of the entire eighteen years of childhood is the day of birth. The “risk society” demands that we do everything possible to reduce those risks to zero.

Lay people often conceptualize risk as a dichotomy: an individual is either low risk (it won’t happen) or high risk (it will happen). But that’s not how risk works. Risk exists on a continuum; the risk varies from person to person depending on a complex interaction of numerous factors. What’s the risk that a baby will die of group B strep meningitis? That depends on the presence of GBS in the mother’s vagina, the exposure of the baby when delivered, and the presence or absence of antibiotics. We can determine the risk of GBS meningitis in large populations, but for the individual woman who carries GBS, we cannot predict the risk that her infant will be infected.

What does this have to do with defensive medicine? Consider that in our risk society we are supposed to reduce our risk to zero. How do we do that? We do that by acting to reduce risk regardless of how small the risk might be.

That represents an entirely new approach. Until the advent of the risk society, we determined which tests and procedures to use by establishing a risk threshold. For example, we know that the risk of stillbirth begins to rise in the last weeks of pregnancy (from about 36 weeks onward). The risk of stillbirth begins to increase precipitous at 42 weeks. So we arbitrarily established the risk threshold for postdates induction at 42 weeks.

Lay people, with their dichotomous view of risk, tend to imagine that there is no risk of stillbirth prior to 42 weeks, and there is a risk of stillbirth after 42 weeks. But the reality is that risk exists on a continuum. Defensive medicine can best be conceptualized at lowering the risk threshold. In the case of induction, the risk of stillbirth starts rising long before 42 weeks. Since the risk society mandates that we reduce risk to zero, doctors feel they have no choice but to offer postdates induction to women by 41 weeks, or even 40 weeks. That’s really the only way to reduce the risk to zero.

This is a critical point. Lay people imagine that defensive medicine offers no benefits to patients and is undertaken solely to protect doctors, but that’s not a complete picture. Defensive medicine is simply lowering the risk threshold. It benefits patients in that the risk of a particular outcome (like postdates stillbirth) is reduced as far as it can be reduced.

So what’s wrong with defensive medicine? Defensive medicine rests on the premise that we must do things to reduce risk. It completely ignores the risks posed by doing things. But that’s not only a feature of defensive medicine, it is a feature of every aspect of a risk society.

Yes, we make cars safer by putting in more safety features, but we increase the price of cars. Yes, we reduce the risk of kidnapping if we don’t let our children play outdoors, but it’s not good for children to grow up cowering inside their houses. Yes, we reduce the risk of illness when we pass laws regulating private habits, but we also reduce freedom. And when we perform more C-sections we lower the risk of neonatal death, but raise the risk of maternal complications.

In our risk society, though, we apparently don’t care. We consider ourselves required to reduce risk of neonatal injury and death to zero, regardless of the other risks or costs that increase as a result.

Where does that leave us in regard to defensive medicine?

First, we can see that defensive medicine is not the use of tests and procedures on people who don’t need them. It’s lowering the risk threshold for using tests and procedures that we previously reserved for higher risk individuals.

Second, defensive medicine is not really a medical issue, but rather a societal issue. To reduce defensive medicine, we would need to give up the idea that we can and should reduce all risk to zero. We would need to recognize that there are negative consequences to reducing risk, as well as positive ones. Most important, we need to figure out how much risk we are willing to tolerate. Zero risk is not achievable, and the price for attempting to achieve it can be very high.

What does this mean for natural childbirth advocates?

First it means an acknowledgement that childbirth is inherently dangerous and that there is nothing trustworthy about birth.

Second, it means that each individual has to determine how much risk she is willing to tolerate and communicate that to her doctor or midwife. Pretending that complications will not happen to you (“trust birth”) is not a strategy; it’s an abrogation of personal responsibility. You cannot give informed refusal to interventions to protect your baby from the risks of childbirth by pretending they are never necessary since that flies in the face of reality.

Finally, it means that blaming doctors for defensive medicine not only isn’t working, but it can’t work. If you want to know the reason for defensive medicine, look in the mirror. Defensive medicine would not exist without the willingness of women to sue for anything less than a perfect outcome.

Natural parenting is a backlash to women’s emancipation.

Grantly Dick-Read was painfully honest that he created the philosophy of natural childbirth as a way to keep women at home; only there could they find true happiness by fulfilling their biologic destiny, and then they would stop agitating for political, legal and economic equality.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Natural parenting promotes the Victorian ideal of women’s proper place … in the home.[/pullquote]

La Leche League and the lactivist movement were founded for similar reasons. Their message that breastfeeding is obligatory because Nature intended for women to breastfed is a reflection of their belief that staying home is obligatory because God intended for women to stay home.

Attachment parenting purports to reflect the science of attachment, but is the exact opposite of what we know about infant attachment. The reality is that attachment parenting reflects the Bill and Martha Sears fundamentalist Christian beliefs about traditional gender roles.

And, of course, natural parenting is always more work for mother. In a society where women can no longer be forced to stay home with small children, natural parenting is the perfect stealth vehicle for manipulating women into believing they must stay home. While ostensibly promoting the wellbeing of infants and small children, it’s really about weighing down mothering with so much work and so much moralizing that a “good mother” can’t possibly do anything but mother.

In other words, natural parenting promotes the Victorian ideal of women’s proper place … in the home.

Victorian ideals were a display of privilege; only families with wealth could afford to allow a mother to stay home. Similarly, modern natural parenting is also a display of privilege.

I’m not the only person to have realized this. In a fascinating piece entitled Twenty-First Century Victorians, Jason Tebbe explains:

The nineteenth-century bourgeoisie used morality to assert class dominance — something elites still do today.

Specifically:

Although the nineteenth-century upper middle class was not nearly as prudish and stern as we imagine, it did adhere to strict behavioral codes. These normative codes reflected the period’s shifting class structure and the ascendant bourgeoisie’s desire to assert its moral superiority …

For this dedication to pay off, however, these enriched Victorians had to display it, making their difference from both the wealthier and the poorer obvious to all.

Today the display of privilege involves conspicuous physical fitness, eating overpriced organic food, getting your child into a good college and natural parenting.

Child-rearing practices get more onerous with each passing year, demanding that parents exercise extreme discipline and self-denial…

Mothers must breast-feed for an extended period, provide only organic food to their children, and keep screen time to nil. Slip-ups indicate failure. This represents perhaps the clearest link between Victorian values then and now: both restrict women and reinforce gender hierarchy.

It’s all about displaying privilege.

It is hardly coincidental that these new expectations require money and time. A working mother who has to juggle multiple service-sector jobs will find it much harder to pump breast milk at work than a woman in an office job. (Not to mention the disparity in parental leave between white- and blue-collar workers.)

And, of course, asserting moral superiority:

The moralistic imperatives now attached to breast-feeding allow working-class women — who are less likely to breast-feed — to be judged moral failures…

Indeed:

Today’s upper middle class maintains the fiction of a meritocratic society, just as the Victorians did. This story allows them to shore up their economic position behind the backs of workers, who are taught that their health problems and dismal career prospects represent individual faults, not systemic dysfunction.

Of course, exercising, eating organic food, and pushing children to use their spare time usefully are not inherently bad things. However, they become markers of bourgeois values when they are marshaled to assert one class’s moral superiority over another and to justify social inequality. It was just as obnoxious in the nineteenth century as it is today.

Natural parenting is simultaneously a display of Victorian sexism (relegating women to the home) and privilege since it implicitly requires marriage and a partner who earns enough to support the natural parenting lifestyle.

That is not a coincidence. Natural parenting is not about children’s needs, it’s about parents striving to display the Victorian virtues of privilege: forcing women back into the home and the sense of moral superiority that comes with it.

Most attachment parenting advocates are strongly opposed to the sleep training method known as “cry it out,” abbreviated CIO.

According to Darcia Narvaez, PhD:

With neuroscience, we can confirm what our ancestors took for granted—that letting babies get distressed is a practice that can damage children and their relational capacities in many ways for the long term. We know now that leaving babies to cry is a good way to make a less intelligent, less healthy but more anxious, uncooperative and alienated person who can pass the same or worse traits on to the next generation.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Letting a hungry breastfed baby cry it out is indefensible cruelty.[/pullquote]

That’s nothing but nonsense, of course, on a variety of levels. It’s nonsense because crying it out does not cause brain damage and it’s nonsense because it is based on the myth of our “noble savage” ancestors who had nothing better to do with their time than endlessly soothe their multiple babies.

But let’s take CIO opponents at their word for the moment. If they honestly believe that CIO harms babies, why do they think it is okay for hungry breastfed babies to cry it out?

Hunger is probably the most elemental of infant drives and, as anyone who has seen an infant scream from hunger would probably agree, is experienced by the baby as suffering. For most mothers, myself included, the sound of their own infant crying is piercing in its intensity and distress. I remember being surprised by this when my first child was born. I had spent my entire professional life surrounded by crying babies and it had never bothered me, yet I found my son’s crying unbearable and always rushed to determine what was wrong and fix it in any way possible. I cannot imagine letting any of my infants cry in out in hunger for any length of time without feeding them.

So why do lactivists think it okay to let babies cry it out for hours at a time because of desperate, all consuming hunger?

Why do they advise women whose babies aren’t getting enough milk in the first few days to CIO arguing that assuaging an infant’s hunger now, when he is suffering, will undermine breastfeeding? Why do they view supplementation in the first view days as an evil so great that it is preferable to force babies to CIO and thereby destroy their brain cells?

Why do lactivists think it is okay to ignore an infant who is not gaining weight because of a maternal milk supply that does not match that infants needs? Why do they denigrate women who find their baby soothed and content after a bottle of formula, and chastise them that they should have let the baby CIO?

Why do lactivists consider maternal mental health/postpartum depression to be a trivial reason for letting babies CIO, but consider that establishing or preserving a breastfeeding relationship is a perfectly acceptable reason for CIO?

Feel free to correct me, but I’m not aware of a single lactivist or attachment parenting blogger who sees anything wrong with letting a hungry breastfed baby cry it out.

Why the hypocrisy?

Because lactivism and attachment parenting have little if anything to do with babies and their wellbeing and everything to do with parents and their self-image. A “good mother” supposedly sacrifices her sleep and mental health and is willing to spend every minute of every day soothing an infant in order to avoid crying it out. But a “good mother” also breastfeeds and therefore, any amount of crying it out is acceptable to preserve bragging rights to exclusive breastfeeding.

 

This piece first appeared in November 2013.

The Academy of Breastfeeding Medicine (ABM) blog has been pretty quiet lately. They haven’t published a single substantive post in nearly 6 months, perhaps because their posts were being systematically torn apart by myself and others.

Now, in the face of a several major publications demonstrating that the Baby Friendly Hospital Initiative (BFHI) is a deadly failure, they’ve returned, desperate to prop up the failing boondoggle.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The Academy of Breastfeeding Medicine is desperate to prop up the BFHI, a failing boondoggle.[/pullquote]

How is the BFHI a boondoggle? Let me count the ways:

• It is a lactation consultant full employment plan
• It gave voice to lactivists’ worse bullying impulses
• It is directly contradicted by science on a variety of issues including the actual benefits of breastfeeding
• It has been known for years that it is killing babies
• It violates women’s bodily autonomy

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 showed that the BFHI doesn’t work, ignores the science 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.

You might think that these findings would engender distress at the ABM and an immediate effort to modify the BFHI to reduce injuries and deaths.

You would be wrong.

Instead it has led to reflexive defense of the indefensible.

The piece is written by Melissa Bartick, MD who has staked her career on massively exaggerating the benefits of breastfeeding. She consistently finds the theoretical lifesaving benefits of breastfeeding despite the fact that she literally cannot demonstrate ANY actual lifesaving benefits to breastfeeding in term infants. I’ve publicly challenged her repeatedly and she has yet to present any real world data to support her extravagant claims.

The title is a bald-faced lie: Evidence is Clear: Baby-Friendly Hospital Initiative Increases Breastfeeding Rates in the US and Closes Breastfeeding Disparities. That’s precisely the OPPOSITE of what the evidence shows.

Bartick skips from one lie to another.

On the benefits of the judicious early formula supplementation:

Yet this editorial is what is garnering the most media attention. Interestingly, the editorial does support previous research by one of its authors, Valerie Flaherman, who found that small amounts of formula help women breastfeed longer. This finding, which contradicts previous evidence (here and here) that non-indicated supplemental formula is a strongly associated with breastfeeding failure.

Bartick’s claim is debunked by the ABM’s own Dr. Alison Steube who wrote in April on the very same website:

Delayed onset of lactogenesis is common, affecting 44% of first-time mothers in one study, and 1/3 of these infants lost >10% of their birth weight. This suggests that 15% of infants — about 1 in 7 breastfed babies — will have an indication for supplementation …

On the failure of the BFHI to increase breastfeeding rates:

A national survey of US Baby-Friendly hospitals compared to hospitals that were not designated Baby-Friendly, the hospitals designated as Baby-Friendly in 2001 had elevated rates of breastfeeding initiation and exclusivity, regardless of demographic factors that are traditionally linked with low breastfeeding rates…

But correlation is not causation especially because the BFHI designation is used as a marketing ploy to attract women for whom breastfeeding is a priority…

One way to look at the correlation between BFHI, the Ten Steps, and Breastfeeding Rates is to look at national data itself from the CDC Breastfeeding Report Cards and the CDC National Immunization Survey, for the years 2007 to 2013, the years in which we have data on the percentage of births in Baby-Friendly hospitals from the CDC. We can look at the following metrics: the number of Baby-Friendly designated hospitals, the percentage of live births at Baby-Friendly Hospitals, the rate of exclusive breastfeeding at 3 months … This data show that the mathematical correlation between the increase in births born at Baby-Friendly hospitals and exclusive breastfeeding at 3 months is 0.93, which is extremely high.

But the rate of breastfeeding was rising dramatically BEFORE the BFHI ever existed. The fact that the rate continued to rise is meaningless. It does NOT show that the BFHI had anything to with the rise at all.

What about the fact that the BFHI bans pacifiers despite scientific evidence that shows that pacifiers prevent SIDS?

Bartick ignores that.

What about the scientific evidence that enforced prolonged skin to skin contact leads to infant smothering deaths?

Bartick ignores that.

What about the scientific evidence that mandatory rooming in policies and closing well baby nurseries leads to infant deaths from skull fractures and smothering?

Bartick ignores that.

The bottom line is pretty simple:

I and others can demonstrate literally hundreds, perhaps thousands, of infant injuries and deaths as a result of the BFHI. In contrast, Bartick and her ABM colleagues offer not even a single term baby whose life has been saved by the BFHI.

The BFHI is a deadly failure. It’s time to end it.

Anti-vaxxers love bibliography salad. They are constantly clogging the comments sections of my vaccine pieces with citations they have carefully cut and pasted from other anti-vaxxers.

As usual, they flatter themselves by imagining that it shows how knowledgeable they are. Sadly for them, it merely confirms their ignorance. That’s because merely being published in a journal doesn’t make a claim either true or relevant.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Ask anti-vaxxers to cite systematic reviews or meta-analyses to support their claims. They won’t be able to do so.[/perfectpullquote]

Their lack of understand fuels their cynicism and the cynicism of many other lay people.

When faced with conflicting scientific claims, lay people often conclude that the truth is simply a matter of what you prefer to believe. Even worse, they occasionally conclude that there is no truth or that the truth is unknowable. It might help, though, to consider a real life example. We know that there are newspapers and news organizations will often report conflicting accounts of political disagreements. And we know that just because we read something in the newspaper, it is not necessarily so.

Reading a scientific paper is similar to reading a newspaper article. Consider the birther “controversy.” A Democratic leaning newspaper may run an article with the headline that Obama was born in Hawaii. A radical Republican newspaper may run an article with the headline that Obama was born in Africa. That does NOT mean that Obama’s place of birth is indeterminate or that we cannot know where Obama was born.

The abstract of a scientific paper is the equivalent of the headline in a newspaper. It tell you the conclusion that the author wants you to draw. It does NOT mean that the conclusion is true, anymore than a newspaper headline means that the article underneath it is true.

The body of the scientific paper is the equivalent of the body of the newspaper article. It offers facts and draws conclusions based on those facts. Even articles with false claims will offer facts. The radical Republicans offer facts for their claim that Obama was born in Africa: his middle name is “Hussein;” his father was born in Africa; there are not many black people in Hawaii. The Democratic newspaper offers facts: it might show a picture of Obama’s Hawaii birth certificate with the official seal; it may have obtained access to Obama’s hospital record from the day he was born.

So we have two articles with two different conclusions and two different sets of facts. Does that mean that we cannot know where Obama was born? Of course not. It is a fact that Obama’s middle name is “Hussein” and it is a fact that his father was born in Africa, but that is actually irrelevant in determining where Obama was born. The birth certificate and the hospital record prove that Obama was born in Hawaii.

Similarly an anti-vax website might run a piece claiming that vaccines are unsafe and ineffective. Medical websites will run pieces claiming that vaccines are safe and effective. The opposing claims do not mean that the safety and efficacy of vaccines are indeterminate or in doubt.

The citations offered by anti-vaxxers do contain facts. For example, they may show that large doses of aluminum are toxic to certain cells in petri dishes. Or they may show that some children do die of vaccine reactions. But that does NOT mean that vaccines are unsafe or that vaccine injuries are common.

So how do we decide what’s true? We look at the scientific evidence in the aggregate. That’s especially important in an area such as vaccine safety and efficacy. There are literally tens of thousands, perhaps hundreds of thousands of papers. Therefore, we look at massive studies (millions of children), and systematic reviews and meta-analyses.

There are many large studies of vaccine safety and efficacy and many systematic reviews and meta-analyses that address these issues. The overwhelming majority of them show vaccines to be safe and effective. That conclusion is NOT undermined by random papers that show large doses of aluminum are toxic to cells in petri dishes and not undermined by case reports of individual children who have rare vaccine reactions.

So if someone comes to you and offers random scientific citations to show that vaccines are either unsafe or ineffective ask them to cite at least ten systematic reviews or meta-analyses to support their claims. They won’t be able to do so … and that’s how you’ll know that their claims are nonsense.

The most important tool of any expert-in-her-own-mind birth blogger is the delete button.

Jen Kamel, commercial real estate professional, and expert-in-her-own-mind birth blogger is an excellent example. Kamel has been banning and deleting for years. Why?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Should women who disagree be seen, acknowledged and respected or silenced and banished?[/pullquote]

• She cannot tolerate disagreement.
• She is incapable of addressing scientific criticism.
• She must prevent readers from thinking for themselves.
• She wants to convince women to pay money for her worthless products (see VBACFacts Academy is the Trump University of natural childbirth)

But that’s not how Kamel sees it. Consider her justification for her recent interaction with a CNM (certified nurse midwife) who publicly exposed Kamel’s advice as dangerous and irresponsible. First Kamel deleted the CNM’s posts, which were scientifically accurate, and then banned her.

Laughably, Kamel attempts to justify her tactics as integrity when they are the exact opposite.

I think it is important to follow people whose beliefs are in alignment with your own. This way as individuals and as a community, we remain in integrity.

That’s not integrity; that’s brain washing.

In that space of integrity, I am known as someone who gets the evidence into the hands of parents, professionals, and providers.

Among obstetric professionals Kamel is NOT recognized as a person of integrity, but rather a shill who charges a fortune for information that is available for free at many other websites; who promotes process (VBAC) over outcome (healthy baby/healthy mother); and who provides false information and deletes correct information when others post it on her Facebook page.

I have had hundreds of health care professionals, such as obstetricians, family practice doctors, labor & delivery nurses, CNMs, and CPMs, attend my programs to rave reviews.

I call bullshit. I’d be surprised if there were a dozen doctors of any kind who would waste money on Kamel’s nonsense.

Most importantly, Kamel let’s us know that she doesn’t like argumentative women on her Facebook page.

Now, from time to time, I come in contact with someone in the community who doesn’t resonate with my mission. This is to be expected in life. I respect their choice to not resonate with the message shared, just as much as I hope in return they respect that I will remain true to myself… speaking out on the importance of VBAC access, the ethics of forced cesarean surgery, the public health implications of VBAC bans, and so much more…

So I if don’t resonate with you, then I humbly and graciously suggest that you might find more joy in someone else’s community.

Yet how would she feel if obstetricians took the same view, ignoring women precisely because they were argumentative over the issue of VBAC or refusing interventions or the right to bodily autonomy? I suspect she would be horrified.

Imagine for a moment that an obstetrician said to a patient:

From time to time I come in contact with a pregnant woman whose desires to not resonate with my views. I will ignore her desires and remain true to myself. If you don’t like my views, get another doctor. If you don’t like my hospital’s VBAC ban, find another hospital. Do not try to change my mind or my hospital’s policy; that would be an assault on our integrity.

Would Kamel agree with that? I doubt it.

If Kamel’s work is about anything at all, it is about making sure that women who disagree with their obstetricians are seen, acknowledged and respected, not silenced and banished. Yet Kamel refuses to make sure that women who disagree with HER are seen, acknowledged and respected; instead she ensures that they are silenced and banished.

Why? Because she cannot tolerate disagreement, can’t address scientific criticism, can’t let women think for themselves, and cannot be diverted from her primary task of making money.

That’s not integrity; that’s hypocrisy.