I don’t know about the rest of the pro-science community, but I’m getting mighty tired of anti-vaxxers swooping in to websites and Facebook pages, defecating all over them with absurd claims about the dangers of vaccines or their components, vomiting random scientific citations they haven’t even read and then declaring they’ve “proved” their claims.

Therefore, I’m offer the Dr. Amy Anti-vax Challenge.

I’m asking for the same standard of proof that any scientists would consider the minimum to support an extraordinary scientific claim.

It’s pretty simple really:

1. Make a claim
2. Provide 3 citations from peer review journals to support it
3. Provide relevant quotes from the papers (not the abstracts)
4. Situate the studies within the preponderance of the scientific evidence
5. Explain why your citations take precedence over scientific consensus

Anti-vaxxers are desperate to be taken seriously by the rest of the world. Here’s the perfect opportunity to show that their claims have scientific merit.

If they’re truly “educated” and have done their “research,” it shouldn’t be hard at all.

I can’t wait to see what they’ve got!

Imagine if I wrote the following:

I cannot sufficiently describe the profound sadness and disappointment I feel upon hearing that the State of California has banned drunk driving. I wanted to write to you to express my thoughts on the matter. It is my sincere hope that you will reflect seriously on my comments, as the consequences of this decision are grave and impactful far beyond the catchment area of your state.

You’d think I was nuts, right? Drunk driving has a terrible death toll and results in tremendous human suffering. Moreover, the person who chooses to drive drunk might not be the person who bears the burden of the injuries and death. Innocent bystanders are often the victims.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breech vaginal birth has a HIGHER death rate than drunk driving.[/pullquote]

The words above were not written about drunk driving. They were written about breech vaginal birth, a practice that has a HIGHER death rate than drunk driving. I paraphrased a public letter posted by Dr. Emiliano Chavira, of ImprovingBirth.org. Dr. Chavira is objecting to the decision by Glendale Adventist Medical Center banning elective breech vaginal birth. ImprovingBirth.org is planning a demonstration in front of the hospital next Wednesday to protest this change in policy.

But drunk driving doesn’t kill that many people. And driving drunk after partying is a long standing tradition.

Continuing the paraphrase:

To begin with, a brief word about drunk driving. This used to be a standard procedure in which all young people (and many older people) routinely indulged. As is also true with sober driving, drunk driving was on occasion, fraught and serious injury or death occurred. A landmark study shows that in 2014 drunk driving accounted for only 4/1000 US deaths each year. Moreover, the majority of auto accident deaths (over two thirds!) involve no drunkenness. Nonetheless, officials in many states banned drunk driving. To this day, the option of drunk driving is denied to all individuals.

But 4/1000 deaths each year is more than enough to justify banning drunk driving. Are we supposed to believe that the HIGHER death toll of breech vaginal birth is trivial?

Dr. Chavira emphasizes that this is an issue of personal autonomy:

[ACOG has] expressed in explicit language that in honor of the ethical principle of patient autonomy, the mother is the ultimate decision maker in the setting of childbirth. They have stated explicitly that competent individuals have the right to accept higher degrees of personal risk. They have also stated that decisionally competent individuals have the right to refuse recommended care, even when needed to maintain life…

But we don’t accept that reasoning when it comes to drunk driving. Why? Because others may be harmed. In the case of vaginal breech birth everyone participating faces the potential harm that comes from losing a baby to a preventable cause. They and the hospital face legal liability. Moreover, society faces the harm that comes from the massive expense of raising a brain injured child.

But medical autonomy is extremely precious, so I have a proposal for how we can preserve women’s autonomy to choose breech birth while simultaneously protecting others.

The obstetricians that choose to offer elective breech vaginal birth should agree to a rider attached to their malpractice insurance. Malpractice insurers set rates by calculating potential financial exposure. That’s why obstetricians have much higher malpractice rates than internists. The insurer could therefore calculate the additional financial exposure posed by breech vaginal birth, divide by the number of obstetricians offering the procedure and charge those doctors more.

Wait, what? That would cost Dr. Chavira and like minded obstetricians hundreds of thousands of dollars? Correct! And that’s where organizations like ImprovingBirth.org come in. Instead of holding rallies and threatening hospitals that refuse to participate in unsafe care, they could indemnify those same hospitals, giving them the financial freedom to accede to ImprovingBirth.org’s demands.

It’s a win-win!

Wait, what? Dr. Chavira and ImprovingBirth.org don’t want to pay. They want hospitals to pay to insure procedures that are unsafe? They want all obstetricians to pay more for malpractice insurance even though most obstetricians think breech vaginal births are unsafe and would not perform them? That doesn’t seem fair, does it?

I believe deeply in women’s medical autonomy. Women most certainly have the right to refuse medical treatment, even life saving treatment. That’s a negative right; the right to be left alone. But they DON’T have the positive right to demand unsafe treatment.

Don’t want a C-section for a breech baby? Fine, don’t come to the hospital for a breech vaginal birth or transfer to the hospital when the baby’s head gets stuck at a homebirth. Doctors and hospitals also have rights; they aren’t required to provide unsafe care.

Freedom comes with responsibility.

Freedom does not mean that you are free to drive drunk and vaginal breech birth is MORE dangerous than drunk driving.

Those who demand the freedom for breech vaginal birth have a responsibility to pay for it. Let’s see them put their money where their mouths are.

It is axiomatic among quacktivists — anti-vaccine activists, organic food devotees, natural parenting advocates — that our world is filled with toxins.

But toxicophobia, fear of toxins, is really just another form of privilege. Only those in wealthy, industrialized societies who have access to copious food and clean water, and are protected from epidemics of infectious disease have the leisure time and financial resources to indulge in internet fantasies of being poisoned by toxins.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Only the privileged have the leisure time and financial resources to indulge in internet fantasies of being poisoned by toxins.[/pullquote]

Sadly, the people who are at highest risk of actually being poisoned by toxins — industrial toxins, lead in paint and water, or simple environmental pollution — tend to be poor, non-white, and too busy trying to survive to have the time, energy or money to indulge in toxicophobia.

What do privileged toxicophobes believe?

Toxins are everywhere. Sometimes these toxins are named; often they are not. In all cases, though, there is no evidence that anyone is actually being harmed by “toxins,” but, of course, proof is not a requirement in the fantasy world inhabited by devotees of quacktivism.

Vaccines supposedly contain “toxins” that cause autism. (N.B. Toxins always and only cause diseases and syndromes whose etiology is still unknown. No one ever claims that toxins cause strep throat, or sickle cell anemia, or gallstones.) Our food supply is purportedly contaminated by toxins too numerous to even bother mentioning by name. Our water supply is supposedly contaminated by the toxins in pesticides. If that weren’t bad enough, Big Farma now wants to flood our food supply with … genetically modified food. And, of course, all medications produced by Big Pharma have myriad secret and toxic side effects.

Poor people have no patience for this nonsense. Consider Whole Foods Market venture into Detroit.

Amanda Musilli, a white, well off Whole Foods employee, lectured a group of poor, black Detroit residents:

I do want to start this talk about what’s different here, because when comparing prices of things, it’s only fair to compare apples to apples,” Musilli said at the August class, standing at the front of the room. “It’s not a fair comparison to compare our grass-fed, organic beef to factory-farmed beef.” … Musilli listed the ingredients Whole Foods prohibits in food it sells: high fructose corn syrup; artificial colors, flavors, and preservatives; irradiated foods; MSG. Whole Foods’ 365 brand didn’t contain GMOs, either, she added, deftly introducing the store’s private label. “Now I don’t know if you guys know that genetically modified organisms are a concern,” she said. “We can talk about that. By 2018 … every product will be labeled and it’s going to be similar to a cigarette label, that this product may contain genetically modified organisms.”

Participants like Toyoda Ruff seemed unimpressed:

While Ruff wanted her family to eat a healthy diet, she wasn’t buying the premise that lies at the heart of Whole Foods’ ideology and marketing: that organic, non-GMO, and corn-syrup-free foods are inherently healthier than the alternative. When it came to grocery shopping, [she] subscribed to basic nutrition guidelines that haven’t changed much in generations: less fat, sugar, and salt, more fruits and vegetables.

“To just go completely organic seems crazy to me,” said Ruff. “If it was a little cheaper, if it was the same price as the other stuff, maybe. But to me, it’s overpriced.” Her usual rule of thumb for determining quality was more pragmatic than the criteria listed by Musilli: “As long as it’s not spoiled, molded, or expired, I’m good with it.”

Food isn’t the only difference. Poor people are not anti-vaxxers. Their children may be behind on their vaccinations because they can’t afford healthcare or couldn’t get to the pediatrician, but not because they fear the vaccines themselves.

Poor people aren’t buying colon cleanses and detoxes; they aren’t spending time steaming their vaginas as recommended by Gwyneth Paltrow. They’re too busy trying to feed and care for their children and themselves.

The ultimate irony is that it is the less privileged who are truly threaten by toxins. Consider the epidemic of lead poisoning as a result of Flint, Michigan’s contaminated water supply. Or contemplate the poor citizens of East Chicago, Indiana where the very soil is contaminated with massive amounts of lead.

Lead is a real poison, with real consequences including the intellectual impairment of children. Hundreds, perhaps thousands of poor children have been harmed whereas no wealthy children have been harmed by the plethora of purported toxins that so agitate their parents.

In truth, toxicophobia is an affectation by which the upper middle class distinguishes itself from the poor. Toxicophobes like to imagine that their effort to avoid toxins marks them as “educated,” when it simply marks them as privileged.

Hey, anti-vaxxers, help me out here!

You’re big fans of vaccine package inserts, right? You’re constantly waving them in parents’ faces insisting that they “reveal” the “truth” about vaccine dangers, right?

So why do you ignore the package insert when it talks about the benefits, efficacy and safety of vaccines?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]You’re big fans of vaccine package inserts, right? So why do you ignore the package insert when it talks about the benefits, efficacy and safety of vaccines?[/pullquote]

According to Stop Mandatory Vaccination:

The risks for each vaccine are stated right on the vaccine package inserts but these inserts are not given to parents or even to adults considering the suggested vaccines for them. It is also doubtful that the doctor or nurse dispensing the vaccine has fully read the product insert…

A full list of contraindications and adverse events listed in the package inserts is available on the Immunization Action Coalition website. While the incidence of any particular adverse reaction listed on the insert may not be unacceptable in the eyes of the manufacturer or the CDC, every parent has both the duty and right to know what they are so that they can decide whether the benefit outweighs the risk for their child or themselves. (my emphasis)

The folks at Stop Manadatory Vaccination, seem to believe that package inserts are so important because they are:

• Accurate
• Filled with valuable information
• Scrupulously honest

Let’s take a look at the package insert for the MMR (mumps, measles, rubella) vaccine. It includes nearly two pages of possible vaccine side effects. Nothing is too small or too rare to be listed.

Looks scary, right?

But there’s more!

According to the package insert, the MMR is highly effective!

Clinical studies of 284 triple seronegative children, 11 months to 7 years of age, demonstrated that M-M-R II is highly immunogenic and generally well tolerated. In these studies, a single injection of the vaccine induced measles hemagglutination-inhibition (HI) antibodies in 95%, mumps neutralizing antibodies in 96%, and rubella HI antibodies in 99% of susceptible persons.

According to the package insert, the MMR has been extensively tested!

Efficacy of measles, mumps, and rubella vaccines was established in a series of double-blind controlled field trials which demonstrated a high degree of protective efficacy afforded by the individual vaccine components. These studies also established that seroconversion in response to vaccination against measles, mumps, and rubella paralleled protection from these diseases.

According to the package insert, the MMR dramatically improves public health!

The impact of measles, mumps, and rubella vaccination on the natural history of each disease in the United States can be quantified by comparing the maximum number of measles, mumps, and rubella cases reported in a given year prior to vaccine use to the number of cases of each disease reported in 1995. For measles, 894,134 cases reported in 1941 compared to 288 cases reported in 1995 resulted in a 99.97% decrease in reported cases; for mumps, 152,209 cases reported in 1968 compared to 840 cases reported in 1995 resulted in a 99.45% decrease in reported cases; and for rubella, 57,686 cases reported in 1969 compared to 200 cases reported in 1995 resulted in a 99.65% decrease.

The package insert mandates scrupulous attention to safety, acknowledges risks, emphasizes informed consent and asks for detailed explanations of any adverse reactions:

The health-care provider should inform the patient, parent, or guardian of the benefits and risks associated with vaccination. For risks associated with vaccination see WARNINGS, PRECAUTIONS, and ADVERSE REACTIONS.

Patients, parents, or guardians should be instructed to report any serious adverse reactions to their health-care provider who in turn should report such events to the U.S. Department of Health and Human Services through the Vaccine Adverse Event Reporting System …

In fact, if you read the entire package insert, you would almost certainly opt to vaccinate your child!

See the paradox?

You claim that package inserts offer vital, scrupulously honest information about vaccines. They do.

So why aren’t you vaccinating?

Finally, a step in the right direction!

After several years of mounting evidence that the Baby Friendly Hospital Initiative (BFHI), designed to promote breastfeeding, leads to preventable deaths of babies being smothered in or falling from their mothers hospital beds, the American Academy of Pediatrics has finally weighed in. Their Clinical Report, written by members of the AAP’s Committee on Fetus and Newborn, Task Force on Sudden Infant Death, is entitled Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There is no evidence that promoting breastfeeding saves the lives of term infants. Therefore it makes no sense to risk the lives of term infants to promote breastfeeding.[/pullquote]

Buried within the oh-so-careful language and grossly exaggerated benefits of breastfeeding is a simple truth:

The Baby Friendly Hospital Initiative mandates practices that kill babies.

And that’s before we address the further deadly impact of restrictions on formula supplementation.

Two of the tenets of the BFHI, the encouragement of long periods of skin to skin contact (SSC) between mothers and babies, and the virtual mandate on 24 hour rooming in are in direct violation of everything we know about infant suffocation and death.

The biggest risk to babies appears to be the risk of smothering. We know that there are multiple modifiable risks for infant suffocation: co-sleeping, prone position, soft bedding, and maternal impairment by opiates. Despite this, the BFHI encourages mothers to co-sleep amid soft bedding and during maternal impairment by opiates, as well as placing babies in the prone position during skin to skin contact.

Why are such obviously deadly behaviors encouraged? It is a misguided effort to promote breastfeeding. The evidence that skin to skin contact and rooming in promote breastfeeding is weak to non-existent. Yet even the AAP cannot resist false claims:

SCC has been researched extensively as a method to provide improved physiologic stability for newborns and potential benefits for mothers. SSC immediately after birth stabilizes the newborn body temperature and can help prevent hypothermia. SSC also helps stabilize blood glucose concentrations, decreases crying, and provides cardiorespiratory stability, especially in late preterm newborns. SSC has been shown in numerous studies as a method to decrease pain in newborns being held by mothers and fathers. In preterm infants, SSC has been shown to result in improved autonomic and neurobehavioral maturation and gastrointestinal adaptation, more restful sleep patterns, less crying, and better growth. Although not specifically studied in full-term infants, it is likely that these infants also benefit in similar ways. (my emphasis)

Of the eleven papers cited in support of this claim, NOT EVEN ONE demonstrates SCC causes benefits for term infants. That’s hardly surprising since the needs of preterm infants are dramatically different than those of term infants and there is NO REASON to suppose that both benefit from SSC in similar ways.

The purported benefits of SSC for mothers are even more tenuous, and based on papers from less rigorous nursing, midwifery and lactation journals.

Even worse, the AAP unforgivably repeats a favorite lactivist canard:

Rooming-in … may avoid newborn abductions …

Really AAP, how could you support such crackpot nonsense?

The truth is that claim that SSC leads improved increased breastfeeding is based on the same “evidence” that vaccines “cause” autism: temporal association, observation and wishful thinking. The rest of the Hill criteria for causation are not fulfilled, especially the mechanism of action and the utter lack of consideration of alternative explanations for the observations.

The sad reality is that tenets of the BFHI are not based on science; they reflect the preferences of lactivists elevated to requirements for other mothers.

This insistence on invoking spurious benefits of SSC and rooming in prevents the American Academy of Pediatrics from recommending the obvious: stop promoting extended skin to skin contact and stop mandating 24 hour rooming in.

Instead the AAP recommends steps that are entirely incompatible with the functioning of contemporary postpartum wards.

… [H]ave no more than 3 dyads assigned to 1 nurse to avoid situations in which nursing staff are not immediately available and able to regularly monitor the mother-infant dyads throughout the postpartum period.

But it takes two nurses per shift to staff a well baby nursery of 30 babies or more, and hospitals are abandoning well baby nurseries in order to save money on those two nurses’ salaries. It defies common sense to imagine that the same hospital is going to double or triple the number of postpartum floor nurses per shift in order to intensively monitor babies in mothers’ rooms.

Reality check:

There is NO EVIDENCE that promoting breastfeeding saves the lives of term infants. Therefore it makes NO SENSE to risk the lives of term infants to promote breastfeeding.

The AAP has taken a long overdue first step in acknowledging that the tenets of the BFHI lead to preventable infant deaths … But they still have a long way to go in explaining why a punitive program designed by lactivists to force other women to mirror their own choices back to them has any place in a facility devoted to promoting infant and maternal health.

I, I, me, me, my birth, my VBAC, my experience, just me, always me!

On Wednesday, I wrote about Dr. Brad Bootstaylor and See Baby Midwifery. DeKalb Medical Center restricted Dr. Bootstaylor’s privileges allegedly in the wake of a profoundly injured baby resulting from an attempted homebirth after two previous C-sections.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]What about the babies who have been harmed? Who gives a shit?[/pullquote]

Apparently that was one injured baby too far, and DeKalb moved to protect mothers and infants (and itself) from a doctor who allegedly violated evidence based standards of care in obstetrics and demonstrated lack of clinical judgment and skill; even his supporters acknowledge that “forceps are not his strong suit.”

How dare the hospital try to protect babies and mothers from allegedly incompetent and dangerous providers? Who gives a shit about injured babies and heartbroken mothers? Certainly not the narcissists in the protest group organized to oppose the dastardly requirement for clinical competence.

They got a lawyer, the husband of one of See Baby’s pregnant clients, Zawn Villines, and began threatening the hospital.

She explains:

By Sunday, we were prepared to begin writing letters. Jeff [Filipovits] sent his first lawyerly letter to the hospital, and many group members began doing the same. This letter-writing campaign continued, and group members began sharing their letters. Jeff had numerous communications with the hospital, was threatening a lawsuit, and knew the specific causes of action under which he could file one.

Then, like a bad penny, Dawn Thompson from ImprovingBirth.org turns up counseling more intimidation:

Dawn Thompson of ImprovingBirth. org got in on things to offer us behind-the-scenes help. She suggested the second protest on Labor Day that we began using as a threat. Many other birth advocates and professionals also got involved early to lend resources. They include, but are not limited, to Brenda Sanders Parrish, Debbie Pulley, Kim Baxley Wilson, and so many more.

Then they met with the hospital to threaten them with a barrage of lawsuits:

Wednesday, we met with the hospital. Jeff made various legal threats. We all made threats. It was not at all a friendly meeting. In fact, I would say that members of our group were more hostile, more aggressive, and more demanding than I have ever seen anyone be in any other negotiation. They were also smart. We didn’t go in and yell. We went in prepared to ask legal questions, to accuse their lawyer of practicing medicine without a license, to threaten lawsuits over forced episiotomies, and so much more.

What about the profoundly injured HBA2C baby and other babies who have been harmed? Who gives a shit? Certainly not the “birth warriors” threatening the hospital.

They were planning their next protest when the hospital’s lawyer called, offering:

*Reinstatement of Dr. B’s VBAC and vaginal breech delivery privileges (except for VBAC3)
*Agreement to provide us with full details about the water birth vote on Monday, as well as agreement that we will get full details about future actions well before October 31.
*Reinstatement of vaginal breech delivery (Dr. B is still the only physician currently providing it)…
*Relaxation of IV and eating rules–please note they’re still saying it’s “hospital policy,” so you will need to be prepare to give a firm no.

What about the babies who have been harmed? Who gives a shit?

There was some sort of quid pro quo:

We canceled the protest for legal reasons we cannot disclose here. This is not an attempt at secrecy, but a recognition of the challenging realities of threatened litigation and hospital politics.

Please understand that if we still had the protest, it is very likely we would lose every single gain we made. That affects real laboring women right now. Their lives are different and better because of this movement. No one’s life has been made worse because of this movement.

What’s next for these intrepid birth warriors?

*Targeted protests against problematic birth policies; we could be like a birth strike force.

*Targeted lawsuits against birth policies, forced interventions, and medical malpractice.

*Working to end the water birth and VBA3C ban …

And, of course:

A new, moderated group that requires a signed commitment to confidentiality to avoid being infiltrated by the Skeptical OB and others (please note anything you say here is effectively public, since the media is here, as well as people who wish to make this group look foolish).

Hey, that’s not right! I’m not trying to make you look foolish. I’m trying to make you look like people who don’t give a shit about dead or injured babies, and you’re helping me do it.

No one has suggested that the hospital is acting for any reason other than to protect babies and mothers. Zawn Villines, Dawn Thompson et al. are threatening to sue the hospital to force them to STOP protecting babies and mothers.

It may be legal, but it is both ugly and unethical.

 

Update: See Baby Midwifery supporters are attempting to pitch NPR a story that DeKalb Medical Center is threatening women with with physical force.

Here’s how they intend to make the case:

***URGENT EMERGENCY POST PLEASE READ***

Some of you received emails for Joel Schuessler stating that women who refuse to exist the water birth tub would be “gently removed.” WE NEED THOSE RIGHT NOW.

…This is VITAL for our news coverage and our legal strategizing. NPR wants to know.

I need this NOW.

L: … Here’s what mine said: “In the event that waterbirths are discontinued permanently, policies and procedures will be in place to safely removed mothers who wish to labor in water to another setting for delivery.”

Zawn: you may have just won this for us

But ACOG and the AAP have clinical guidelines that say waterbirth is dangerous for babies.

Who gives a shit about the babies?

Where does Dr. Bootstaylor stand on what has been happening?

“THANK YOU” everyone from my inner core to outer sanctum in the spirit of honoring birth, choices, and shared decision making.

I’m truly humbled and honored to be in alignment with all Mothers and Families

Bring Birth Back!

What about the babies that have been harmed or will be harmed?

All together now: Who gives a shit about the babies?

Is Dr. Brad Bootstaylor another Dr. Wonderful?

Long time readers may remember the story of the original Dr. Wonderful, Robert Biter, MD. Back in 2010 Dr. Biter had his obstetric privileges at Scripps Encinitas suspended. Natural childbirth advocates held marches, conducted a letter writing campaign, and blogged in support, all without having any idea of the charges against him.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It’s almost as if they don’t care about the babies harmed at their hands.[/pullquote]

It turned out that he was facing multiple malpractice suits for having harmed multiple patients. His behavior was so egregious that he was eventually stripped of his medical license.

At least in that case, Dr. Biter’s supporters did not know why privileges were revoked and simply assumed that is was because of his support for homebirth, waterbirth, etc.

In the case of Dr. Brad Bootstaylor, his supporters profess surprise and anger that his privileges have been restricted. His practice, See Baby Midwifery, is organizing a rally in support and has contacted multiple media outlets to express their outrage.

There’s just one problem. They KNOW that many babies have been injured and harmed by Dr. Bootstaylor and the midwifery practice; they’re simply lying about it to the public.

On August 21, See Baby Midwifery posted the following:

To our amazement and disappointment, See Baby Midwifery was advised by DeKalb Medical on 8/17/16 (Wednesday) that we can no longer support birth options for mothers to include VBAC, water birth and vaginal breech births. This sudden and unexpected lack of support brings great concern to us and our community.

Temporarily, all VBAC eligible and breech presenting patients will be birthing at Emory Midtown with Brad Bootstaylor, MD.

Water birth has also been discontinued however water labor, of which the majority of patients benefit most, is still supported and available to you (birthing pool, shower, tub, etc.).

Midwifery services will continue at Dekalb Medical for all other patients…

Having this type of news come out of nowhere, is something we are empathetic to, and we share in that frustration wholeheartedly… (my emphasis)

But, in truth, they’ve known all along that multiple babies have been harmed by their practice.

In a private group planning the protest, a supporter acknowledges:

… I saw some information about this whole policy change being due to a bad outcome with a VBA2C birth this week…

Indeed:

There was no loss. There was a transfer [from home] that resulted in a rupture but mom and baby are alive… This was a significant complication. Catastrophic.

Evidently there are problems with Dr. Bootstaylor’s use of forceps, too, which elicited this chilling acknowledgement:

I am a bit biased and I truly love Dr. B but forceps are not his strong suit.

But wait! There’s more!

…[T]here have been many bad outcomes over the months regarding water birth. She said there have been more babies being sent to the NICU since See Baby [Midwifery] was there than ever before…

There was an emergency meeting of the DeKalb OB department last night. A doula reports that Dr. Bootstaylor told her:

30 OBs at the meeting. Many felt waterbirth was forced upon them. See Baby [Midwifery] was invited there in the beginning… He says it feels that they are now being uninvited…

Could it be because their obstetrician presided over a homebirth disaster, is so unskilled with forceps that the support staff has noticed, and an unusually high proportion of babies from their practice is ending up in the NICU?

The OB department wants to restrict Dr. Bootstaylor’privileges:

Was forced to sign the VBAC and breech and forceps or lose privileges. Voluntary refrainment of these practices.

The restrictions on Dr. Bootstaylor and See Baby Midwifery have been put in place in the wake of bad outcomes that represent real babies who have been harmed, possibly grievously, possibly permanently.

Has See Baby Midwifery been honest with its patients and other members of the community about what has happened. Of course not!

See Baby Midwifery shared that Dr. Bootstaylor’s privileges have been restricted, but not why they have been restricted. It’s almost as if they don’t care about the babies harmed at their hands, only about the ones that they can still profit from.

What did See Baby Midwifery do about their bad outcomes? Did they perform root-cause analyses? Did they modify their practice to prevent further outcomes? Of did they just bury them, hoping no one would notice about the trail of damaged babies they left in their wake?

The outrage here is NOT that DeKalb Medical Center moved to restrict Dr. Bootstaylor’s practice. They are legally and ethically required to act. But Dr. Bootstaylor and the midwives of See Baby are ALSO legally and ethically required to act. Instead, they tried to rally support for their harmful practices and figuratively bury the babies that have been injured at their hands.

They should be ashamed of themselves.

I have been arguing for years that the Baby Friendly Hospital Initiative (BFHI), designed to promote breastfeeding, ignores scientific evidence and leads to preventable deaths of babies.

A new paper in JAMA Pediatrics confirms what I have been saying.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]A practice designed to promote breastfeeding is injuring and killing babies.[/pullquote]

It’s entitled Unintended Consequences of Current Breastfeeding Initiatives. Breastfeeding is a good thing and should be vigorously supported, but:

Unfortunately, there is now emerging evidence that full compliance with the 10 steps of the initiative may inadvertently be promoting potentially hazardous practices and/or having counterproductive outcomes.

The authors note a variety of serious problems with the BFHI:

1. Enforced prolonged skin to skin contact leads to deaths from Sudden Unexpected Postneonatal Collapse (SUPC).

Reports of SUPC include both severe apparent life-threatening events (recently referred to as brief resolved unexplained events) and sudden unexpected death in infancy occurring within the first postnatal week of life. A comprehensive review of this issue identified 400 case reports in the literature, mostly occurring during skin-to-skin care, with one-third of the events occurring in the first 2 hours after birth …

And inevitably:

…[A] recent publication from the American Academy of Pediatrics observed that lawsuits have surfaced in US hospitals attributed to unexpected respiratory arrest in apparently healthy newborns during early skin-to-skin care …

In other words, a practice designed to promote breastfeeding is injuring and killing babies.

2. Infant injuries and deaths as a result of enforced 24 hours rooming in and closing well baby nurseries.

An overly rigid insistence on these steps in order to comply with Baby-Friendly Hospital Initiative criteria may inadvertently result in a potentially exhausted or sedated postpartum mother being persuaded to feed her infant while she is in bed overnight … This may result in prone positioning and co-sleeping on a soft warm surface in direct contradiction to the Safe Sleep Recommendations of the National Institutes of Health. In addition, co-sleeping also poses a risk for a newborn falling out of the mother’s bed in the hospital, which can have serious consequences.

3. The ban of formula supplementation is contraindicated by scientific evidence.

…[W]hen supplementation was given for a medical indication, there was no adverse effect on the duration of breastfeeding.

4. The ban on pacifier use is contraindicated by scientific evidence.

[The BFHI] requires that mothers be educated repeatedly that pacifiers may interfere with the development of optimal breastfeeding. Because there is strong evidence that pacifiers may have a protective effect against sudden infant death syndrome (SIDS), the American Academy of Pediatrics has suggested avoidance of pacifiers only until breastfeeding is established at approximately 3 to 4 weeks of age. Because a substantial number of SUPC events occur during the first week of life, this recommendation to proscribe the use of pacifiers is difficult to defend based on risk.

So the BFHI leads to preventable infant injuries and deaths and the ban on formula supplementation and pacifier use are contraindicated by scientific evidence and may lead to further injuries and deaths from dehydration. Yet, health organizations are promoting the deadly BFHI tenets.

Preventing the unintended serious outcomes from these practices has been made more challenging by the emphasis on breastfeeding exclusivity in the perinatal measures recently promulgated by The Joint Commission. Measure PC-05 requires documentation of the reasons for not exclusively breastfeeding, with no allowable exceptions for newborn conditions. In addition, the Centers for Disease Control and Prevention actively promotes the “10 Steps” and Baby-Friendly designation, and monitors “10 Steps” compliance in the United States. In Massachusetts, the recently enacted Massachusetts Health Quality Measure 3A requires increasing rates of breastfeeding exclusivity, with soon to be implemented financial implications.

Why have these deadly measure been promoted? It’s certainly not because they benefit babies (or mothers). They have been promoted because of extensive lobbying on the part of the breastfeeding industry and the lactivists who support it. The BFHI should more properly be called the Lactivist Friendly Hospital Initiative because that’s who benefits.

As the authors note:

If government and accreditation agencies wish to encourage and support breastfeeding, their focus should shift from monitoring Baby-Friendly practices and breastfeeding exclusivity to monitoring breastfeeding initiation rates coupled with evidence of lactation support both during and after the hospital stay. More attention should also be placed on ensuring compliance with established safe sleep programs, emphasizing the need to integrate safe sleep practices with breastfeeding. Hospitals should direct their efforts toward implementing practices that will promote breastfeeding safely, the common goal of both private and public groups with an interest in these issues.

If doctors, hospitals and public health officials truly care about the wellbeing of babies, they will end the BFHI.

It is perhaps the ultimate irony.

Advocates of attachment parenting many of whom reject vaccination because of fear of autism have failed to recognize that it is attachment parenting itself that causes autism.

Consider the ever growing body of evidence:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There has never been a randomized controlled trial of attachment parenting that shows it doesn’t cause autism![/pullquote]

1. Both autism and attachment parenting have increased dramatically in the past two decades. The origin of the attachment parenting is credited to Dr. William Sears, who first mentioned it in his book in 1988. Studies show that in the VERY SAME YEAR, the incidence of autism began to rise dramatically. (Environ. Sci. Technol., 2010, 44 (6), pp 2112–2118).

2. Regardless of who practices attachment parenting or how they define it, no one can deny that the practice of attachment parenting ALWAYS precedes the diagnosis. There are no known cases in which attachment parenting practices began after autism was diagnosed.

3. The purported mechanism is thought to be the sensory deprivation caused by baby wearing and extended breastfeeding. During the critical early months and years, when babies should be learning about the world and making millions of neuronal connections, babies exposed to AP are deprived of contact with the outside world (many are constantly carried in a position where they can see nothing but the surface of the mother’s clothing) and their exposure to other individuals such as fathers, grandparents and childcare workers is severely limited.

4. No one has EVER shown that attachment parenting does not cause autism.

5. Even those who strongly reject the notion that attachment parenting causes autism acknowledge that there are MANY children raised with attachment parenting who are subsequently diagnosed with autism.

6. Many of those who deny a link between attachment parenting and autism stand to lose money if attachment parenting is shown to be harmful. Authors, lactation consultants, and sling manufacturers, among others, have a strong economic motivation for discouraging investigation of this link.

It is time to launch a comprehensive investigation of the harmful side effects of attachment parenting in general, and the relationship between attachment parenting and autism in particular. It’s hardly coincidental that the same people who make money from attachment parenting have NEVER bothered to study these harmful effects. They insist that attachment parenting is beneficial, but there is no way they can know for sure.

****

Those who have read this far have probably figured out that this is a satire. I’m satirizing the “thinking” of anti-vaccine parents on the purported relationship between vaccines and autism. The purpose of the satire is to demonstrate that what seems to anti-vaxxers to be irrefutable “reasoning” is nothing more than nonsense and logical fallacies.

The above list highlights the major rhetorical gambits of anti-vaxxers. Number 1 is the claim that because both vaccination and autism have risen in recent decades, vaccines must cause autism. That claim is foolish as can be seen when the same observation is made about attachment parenting and autism. Just because the incidence of two phenomena rise at the same time does not mean that one caused the other. And that doesn’t even take into account the fact that rates of vaccination have actually been FALLING while rates of autism have been rising.

Number 2 is the temporal connection. Early childhood vaccination precedes the observation of autistic symptoms, but a lot of things precede the observation of autistic symptoms. That’s because those symptoms typically do not appear until the early toddler years and anything that takes place during infancy (like attachment parenting practices) will precede the observation of symptoms.

Number 3 invokes a spurious mechanism of action. It is certainly plausible, but no evidence is presented that it actually occurs. Anti-vaxxers play the same tricks with claims about the deleterious effects of “toxins” in vaccines.

Number 4 is the “argument from ignorance.” The argument from ignorance dares the opponent to prove a negative and when a negative cannot be proven (since that is a logical impossibility in most cases), the conclusion is proclaimed that this “shows” that vaccines cause autism.

Number 5 is the “fallacy of the lonely fact.” Since some children have developed autism after their parents practiced attachment parenting, the conclusion is drawn that large numbers of children will develop autism after their parents practice attachment parenting.

Number 6 is the conspiracy theory that undergirds almost every attempt to defend anti-vax. But when the same “reasoning” is applied to attachment parenting, it is easy to see that the conspiracy theory does not have much explanatory power. There is ALWAYS someone who stands to benefit from any recommendation or practice. That does not mean that those who benefit are actively hiding information on harms and risks from everyone else.

The concluding paragraph is the seemingly innocuous call for “more research.” But we cannot and should not waste time “researching” connections that have no basis in science. If we did, we could spend a lot of time “researching” whether the moon is made of green cheese or whether clouds are made of marshmallows. The call for “more research” is just away to add gravitas to what are often ridiculous claims. We do not need to “research” every wacky idea that anti-vaxxers devise and our refusal to “research” those ideas without basis in science or logic is not a sign that someone is hiding something.

The key point is that what passes for “reasoning” among anti-vaxxers is not reasoning at all. It is nothing more than wild accusations, logical fallacies and conspiracy theories. There is no more reason to take seriously the idea that vaccines cause autism than there is to take seriously the idea that attachment parenting causes autism.

She writes on her Facebook page:

While I am proud of myself for birthing and catching my baby myself, thankful he was strong enough at that age to be saved, I don’t feel like I did anything super or amazing…

That’s good, Paala, because you didn’t do anything super or amazing. You did something immature and despicable. You risked your baby’s life by repeatedly defying the doctors who were working desperately to save him.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]”Labor by myself with my baby, just us, and I’d birth him and catch him and then call for help.”[/pullquote]

Early in the second trimester, Palaa’s began suffering a serious and growing placental abruption. Thus began the effort to save Palaa’s son by keeping in the womb and long as possible. That must have been very difficult for Palaa since her identity is based on her childrearing choices:

I write about my journey through motherhood as co-sleeping, babywearing, full-term breastfeeding parent to four wonderful children. We spend our days unschooling, exploring nature and all that the … area has to offer. I’m also a birth, breastfeeding, and women’s rights advocate so I post about those as well.

Simply following medical advice in an effort to save her son’s life did not offer enough scope to burnish her crunchy mom cred, so she acted like a willful toddler repeatedly defying medical advice.

…One day in December when I was 14 weeks along. I had what seemed to be an all day Braxton Hicks contraction, quite painful if anything bumped my belly, that ended in a gush of blood as I walked up my stairs at the end of the day. Bright red blood out of no where was worrisome… [W]hen the bleeding repeated itself once more the following day, I reached out to my birthy friends and took a tincture a trusted ex-midwife friend of mine suggested, drank lots of tea, and then all was fine.

Her baby freebirth was at risk!

I wasn’t able to envision a sweet home freebirth like my last one… I still hoped for the best, even as I bled occasionally. It wasn’t serious enough to warrant a trip to the hospital until I had a larger gush than usual.

She sought treatment at the hospital at 22 weeks:

I didn’t like the florescent lights, strangers that hardly made eye contact, the chilly doctor wasn’t soothing at all, didn’t put her hand on my skin, on my belly once while I was there for a couple hours, just touched me with tools and sent me to get an ultrasound. I also came during dinner time and no one offered an obviously pregnant woman anything to eat or drink. Not even a snack like they had sitting around.

She was released home and at 23 weeks and 3 days she had another “huge gush of blood,” bleeding through pad, pants and sheets and on to the mattress.

Did she go to the hospital? Of course not:

While I was in the shower, I assessed myself and considered my situation. In addition to the painful, regular contractions and bleeding, felt my cervix opening up from when I checked a few hours earlier…

I started driving to the hospital with a NICU 25 minutes away and kept tracking contractions…

When she got there:

…I told her I was 23 and 4, contracting every 2-3 minutes, they were painful, I was dilating, I was bleeding heavily, I had a SCH, I could feel the baby kicking fine, and I was there to get some labor stopping drugs. She had me fill out paperwork, put some plastic name tags on my wrist, and sat me down in a triage room and I gushed more blood, waiting to see someone. I wasn’t treated with urgency or offered any water, juice, or anything.

Imagine that! She bled for hours at home before she could be bothered to go to the hospital, showed up at 3 AM and there was no doctor to attend to her.

Everyone was so mean. [Could it be because they were incredulous at her willingness to ignore the potential death of her child?]

At 4:30am, an hour after arriving, the doctor on call finally arrived. She had a gruff beside manner, zero warmth. She shoved a couple of gloved fingers in me and confirmed what I’d been telling them, that I was dilated a couple centimeters. She said I was 80% effaced and she was going to start me on magnesium to stop labor. Oh and my baby was breech.

And then, horror of horrors, she had to put on a hospital gown.

By 6am, my husband got my message and I was given the first of two steroid shots, betamethasone, to mature my baby’s lungs in case he was born early and was started on magnesium sulfate intravenously with an IV drip to hopefully stop my labor. Thankfully, my labor slowed and then eventually stopped. The mag made me feel slow and hot…

Oh, and she got 5 units of blood!

By noon on Thursday, I was given 3 pints of blood. Apparently, I was only at 20% blood volume when I walked in. I was given 2 more pints in the next day to bring me back into the normal range… I had to fight to eat, telling them repeatedly that I was not going to have a CS at 23 weeks (my body, my baby, my choice), and I was pregnant and starving, that I needed to eat. Withholding food was unacceptable.

The next morning she woke up to a painful contraction. Did she tell anyone? No.

I went into steady labor again. I couldn’t sleep and I felt awful. I needed a shower. I wrapped up my IV and line ridden arm with a plastic bag and some tape that I found and rinsed off in the shower. I gently felt that I’d dilated another 2 cm and told my nurse so I could get started on mag again…I was given a second shot of betamethasone.

The mean people at the hospital tried to impress the seriousness of the situation on her but she didn’t get it.

The doctor on call scolded me for checking myself and told me to keep my hands out of my vagina. I’m pretty sure I gave them the “eff off” eyes because it was my body, I had made sure my hands were clean, and I knew I was more gentle with myself than they were.

Everyone continued being mean:

I continued being checked and prodded all day, all night. I had bruises on my arms for too many bad blood draw and IV attempts. I had to convince each new doctor and nurse that I didn’t want continuous fetal monitoring and I wasn’t going to have a c-section, that I could continue to eat. It was a constant fight to be listened to and left alone. It felt like it was all about control and slowly breaking me. I couldn’t believe this was standard care, that women were treated this way. Where was the respect?

I, I, me, me, my feelings, my need for control, me, me, MEEEE!!!

At this point, I asked the doctor of the day if I could eat outside because I was craving the outside world. He denied my request. I ignored the doctor’s orders on Sunday evening and went outside into the garden and ate my dinner outside before sunset with my husband.

Palaa’s baby is on the verge of viability, sure to be born early, and everyone is struggling to make sure he stays inside for as many extra hours or days possible.But Palaa found ignoring doctor’s orders to be delightfully transgressive.

So delightful that she continued defying the medical professionals:

By 8:30, I had enough. I took out my IV lines (nothing was being pumped into them at that point anyway) and my hospital bracelet. I wanted to take a shower with both arms free of junk. I figured they could put that crap back on me if it was an emergency but I needed to feel like myself again. (Did I mention they tracked and measured everything that came out of my body?)

Here’s the best part:

By 10pm, my body started going in to labor again. My husband was going to sleep and asked me if was okay. I said I just felt pushy, like I needed to poop. I blamed the start of a new round of contractions on the prune juice, them feeling like they needed to get me to poop and mess with my body. I went to the bathroom while he fell asleep on the fold out chair in the room. He was exhausted.

After a shower and sitting on the toilet a couple trying to poop, I realized I was in labor. I thought about my options as I sat in the bathroom. I’d been told my body only needed to open to 5 or 6 centimeters until my baby would come out because he was so small.

Palaa had to decide what to do.

Option 1. Call the nurses and either be prodded while birthing right there or be wheeled in for an emergency CS.

Option 2. Wake my husband and labor with him secretly but then I knew he’d lose his cool and call for help.

Option 3. Labor by myself with my baby, just us, and I’d birth him and catch him and then call for help.

Surprise! She went with the most transgressive choice!

Obviously, I went for option 3. It seemed like the safest thing for my baby and myself at the time. The studies I’d read didn’t report benefits for a c-section for babies of his age, that vaginal would have been safer, and I knew getting drugged up and controlled by strangers was going to make things dangerous for us. After a couple of painful contractions by the toilet, I laid out a couple of chux pads to catch the blood and crap I was sure was coming.

I kid you not!

My body slid Evar out, everything else, too, placenta and all in one contraction as I knelt down on the chux pads. I caught my baby boy and his bag of water broke as it hit my hands. I admired him and felt the relief of everything coming out. He looked perfect, though tiny, healthy, eyes closed but breathing, and I heard him cry.

Then she told her husband the baby had been born.

He jolted awake, ran out of the door to the nurses station at the corner to call for help. He said they were shocked and took a moment to move.

An ALS nurse came in a minute later and assessed Evar. He asked if we wanted to save him. We asked how he thought he was doing based on his professional opinion. He said he looked good and we said yes. (Babies born before 25 weeks are not saved unless the parents request it.) He milked the cord to give him more blood and then cut it. I was thankful it wasn’t too rushed but I wished he had carried the placenta up with the baby instead of cutting it…

She’s so proud of herself:

I had an unassisted freebirth, en caul just like my last baby, except in the hospital …

What about the baby?

He weighed 1 pound 6 oz, but survived. He spent four and a half months in the NICU and is doing well … no thanks to his mother who nearly killed him in her quest for bragging rights.