I knew this day was coming, but I’m pleased that it has arrived sooner than I expected. Lactation professionals are backpedaling as fast as they can.
I’ve been writing for years that lactation professionals in general, and Baby Friendly USA in particular, have been ignoring scientific evidence in favor of personal biases. Babies and mothers are suffering (and in the case of babies, dying) as a result.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The scientific evidence shows: Fed Is Best![/pullquote]
Along comes Marsha Walker, IBCLC to confirm it.
Walker essentially proves the contention of the JAMA paper that she is commenting upon. That paper found that the World Health Organization reviewed the latest evidence on breastfeeding and then proceeded to IGNORE it.
Specifically, the WHO noted but ignored the scientific evidence that pacifiers reduce the incidence of SIDS, that pacifiers do NOT interfere with breastfeeding and that early judicious formula supplementation does NOT interfere with breastfeeding. In addition, the WHO recommended policies for which there is NO EVIDENCE, including mandatory rooming in of babies and mothers, skin-to-skin beyond the first hour after birth, and the use of donor milk instead of formula for term infants.
The authors conclude that in both cases, stakeholder bias was allowed to take precedence over the actual scientific evidence.
This is a powerful critique (and confirmation of much of what I’ve been writing for years) but Walker tries to justify ignoring the scientific evidence that she doesn’t like. We don’t need high quality evidence for breastfeeding policies because breastfeeding is natural!
The use of the GRADE method and systematic reviews in this synopsis may not necessarily represent the best framework for evaluating interventions for an essentially normal process. Breastfeeding is not a medical problem…
This is so disingenuous that I wonder if Walker actually believes it. I doubt that she would accept scientific evidence that contradicts what she believes about breastfeeding UNLESS it was evidence of the highest quality. So to argue that it can be ignored BECAUSE it is the highest quality is bizarre.
The response by Bass, one of the authors of the original paper, is devastating:
Her statement that the synopsis used the GRADE method is inaccurate because that evidence assessment method was actually used by the World Health Organization (WHO)2 and is widely used and respected because of its rigorous approach to evidence rating. Suggesting that a lower level of evidence was warranted because breastfeeding is not a medical problem reflects confusion concerning the purpose of the BFHI guideline: to analyze the best manner to support breastfeeding, not to judge the value of breastfeeding.
Furthermore:
This resistance to evidence that challenges BFUSA compliance criteria can inadvertently result in unsafe outcomes including sudden unexpected postnatal collapse4 and newborn falls, which have been associated with BF designation…
But Walker is hardly the only lactation professional attempting to backpedal as fast as she can.
Prof. Amy Brown is arguably the fastest backpeddler of them all.
In her latest piece for HuffPo, Brown is shocked, shocked to discover that some women cannot produce enough breastmilk. This represents a complete about face from articles she has written in the past.
In May of 2016, in the cruelly title article Why Fed Will Never Be Best Brown claimed:
Physiologically speaking only around 2% of women should be unable to breastfeed …
[T]he reason why we are struggling so much with breastfeeding is for most not initially a physiological issue…
As recently as December 2018, Brown had the temerity to suggest that women who alert others to the risks of insufficient breastmilk should be ignored:
Try not to pay too much attention to breastfeeding horror stories. People like to share stories – it makes them feel better – without thinking about the consequences for you.
There’s no mention in that piece of what Brown just discovered: some of those horror stories are true.
But give Brown credit for smartly performing an about face. Now not only is insufficient breastmilk much more common that Brown previously acknowledged, it’s the fault of doctors!
Given the breadth and depth of medical knowledge, why do women still not have answers if they can’t breastfeed?
How lovely that after years of repeatedly being informed by women that they weren’t breastfeeding because they had inadequate milk supply, Prof. Brown has suddenly discovered that some women have inadequate milk supply. For years women have struggled with shame, guilt and self-hatred induced by lactation professionals like Brown who refused to listen and berated them instead. I wonder if she plans on apologizing for her years of gaslighting these suffering women and treating them cruelly. Somehow I doubt it.
What’s the take away message from all this lactivist backpedaling?
First, as I and the Fed Is Best founders have been writing for years, contemporary breastfeeding promotion efforts like the Baby Friendly Hospital Iniaitive IGNORE the scientific evidence.
Second, babies and mothers have been harmed by the lactivist insistence on placing their personal biases above the scientific evidence.
Third, lactation professionals aren’t going to back down without a fight.
Whether it’s Marsha Walker pathetically insisting that we can ignore high quality scientific evidence because breastfeeding is natural or Amy Brown brazenly insisting that the problem of insufficient breastmilk — a problem whose existence she denied until yesterday — is both real and the fault of doctors, lactation professionals will maintain breast is best for every baby and every mother. It doesn’t matter to them both scientific evidence and real world experience show that’s a lie. That’s why you should ignore lactation professionals who ignore scientific evidence.
The final take away message is the most important of all:
Fed Is Best!
Sometimes I think lactivists are driven by a very naive and idealistic view of ‘nature’. Breast-feeding is natural, therefore it must be perfect and good and it must automatically work.
Nature wants us dead. The whole of human history has been one long drive to overcome nature-to build shelters to protect ourselves, to develop medicines to overcome disease, to develop technologies allowing us to overcome geographic distances and obstacles. All ‘nature’ needs is for you to replace yourself, and then die. It doesn’t care about half of your children dying before their first birthday as long as the human race has sufficient numbers to continue the species. Nature doesn’t need body organs to function perfectly, as long as they function well enough to keep you alive to reproduce and replace yourself. Our biological systems are the same as they were back in the paleolithic era-we aren’t special, we aren’t top of the evolutionary tree, all the advantages we have over other animals are because we had the brain power to overcome some of nature’s adverse effects.
Other animals have huge litters, or lay loads of eggs at a time, all in the hope that at least one or two will survive. There’s a thing called semelparity (suicidal reproduction). Some animals mate themselves to death, mostly insects but there is at least one mammal doing this, the Antechinus (its an odd little Australian mouse creature). They mate, disseminate their sperm far and wide and then die when their immune system goes into overdrive. But that’s what ‘nature’ does-all it needs is for that mouse to produce at least one viable offspring, and after that, who cares?
Which is why you can’t trust to nature to get breast-feeding right-just because we are biologically designed to produce milk, doesn’t mean to say that we can. If it works, great-if it doesn’t, we have various other options and alternatives. Imagine if your kidneys suddenly stopped working-you wouldn’t be told ‘just keep trying, I’m sure you can produce some pee if you worked harder at it’… So why do they react in that way to malfunctioning breasts?
And to be really blunt, ‘nature’ doesn’t really care if the human species survives. Nature will continue with or without us, just ask the dinosaurs.
Absolutely. If ‘nature’ was an entity, I suspect it would be working hard to get rid of us seeing the problems we’ve created for it! Look at extinction-yes, anthropogenic extinction is something we need to address and species dying out solely because of the impact of humankind on the environment is a very definite issue. But looking at extinction generally, it is a natural phenomenon and biologists talk about background/normal extinction rates. It’s part of the cycle-species go extinct. So if nature doesn’t care about entire species, its certainly not going to bother about breast feeding.
Successful breastfeeding isn’t a medical issue; unsuccessful breastfeeding (as in the baby isn’t getting enough to eat or Mom is sliding into ppd/ptsd/etc because of it) most certainly becomes a medical issue. Looking about isn’t a medical issue either, until you need glasses or even the white cane.
What I thought was interesting from Brown’s article was this quote: “If you ask a mother why she wanted to breastfeed, she will say how it helped her baby’s health. True, but there is another primary reason why breastfeeding is important – a woman’s right to have her body function as she expects.” In other words, women are saying they want to breastfeed because they have believed what lactation consultants and other healthcare providers have told them. But let’s move the goalposts and say that we just have a right to have our bodies do what we want. I’d like my body to function as I expect, but I struggled with infertility with my first, then developed preeclampsia in both pregnancies – at 39 weeks with the first, and at 27 weeks with the second. I also had a hemorrhage after my second was born. My eyesight is horrendous, and I have weak ankles. I have gotten over believing that my body is always going to function the way I want it to, and I don’t feel particularly bad about that as long as it doesn’t interfere with my daily functioning.
I felt terribly guilty that I couldn’t breastfeed my first, because I believed that it was necessary for bonding and my baby’s health. My tears and sobs and guilt weren’t because my body wasn’t functioning the way I expected; they were because I had been led to believe that if my body didn’t work in this way, I would be an inferior mother. Take away the moralizing associated with breastfeeding, and I believe you’d get rid of almost all the angst when it doesn’t work out.
“a woman’s right to have her body function as she expects”
Wait what?
We have a RIGHT to have our bodies do what we want them to?
That doesn’t even make sense. Our bodies fail us all the time (heart attacks, infertility, inability to run a marathon, etc.). That’s just the nature of bodies, not the violation of a right.
Plus a big lesson of life in general, as well as of parenting in particular, is that things don’t go the way you think they will, and you improvise. You have to parent the kid you have in the situation that you are in with the resources that you have. If you want to breastfeed and breastfeeding works for you and your family, great. If not, formula is a viable option and you move on and deal with whatever comes next.
Right, exactly! Parent the kid you have. Deal with the body you have. If it “fails” to breastfeed, so what? Some people’s bodies fail to run marathons, fail to live past age 40, fail to ever walk, fail to stay slim, fail to look good, etc. etc. Hardly anyone has anything close to a perfect body. SO WHAT? Deal with it and move on.
I’d have really liked for my body to “function as I expected”. Instead I got 6 preemies, 3 of whom died and one of whom came real damned close. Having three dead babies pretty much sucks, but my body doesn’t “function as I expect” with pregnancy.
I can’t “like” your comment, but I hear you.
Thank you. I am unusually sensitive right now. Some things are going on an I am not in a good mental space. This sort of nature worship is just getting to me more than usual.
Hang in there, Beatrice. “This too shall pass”
https://uploads.disquscdn.com/images/4969d08195a463f522af0e2e1daf0daf899bdb9ce278135599c800175c8f615b.jpg
I think it’s quite reasonable for someone with a history of losses to take exception to that phrasing.
I hope things get better soon-give the parrots a hug and look after yourself
*hugs*
wait, I have a RIGHT to have my body function as I expect? So my severe nearsightedness, my extra 10 pounds, and those crow’s feet around my eyes are all violating my rights?
who do I sue, and where do I pick up the check for damages?
Yeah I think pregnancy and childbirth plus the aftermath generally are, for a lot of us, a pretty hard lesson in bodies not functioning as one expects…
My daughter is completely convinced that yes she can climb this or jump off that and land just fine. She also -expects- we can travel to the Island of Sodor and meet Thomas. What kind of childish nonsense is she going on about. Who has a _right_ to all their expectations?
“A woman’s right to have her body function as she expects.” That quote skeeves me out.