One of the themes of this blog is that natural childbirth advocacy, homebirth, lactivism and attachment parenting have little to do with birth, babies or children. They are about mothers and how they would like to see themselves, specifically how they would like to boost their fragile self-esteem by denigrating other mothers.

In my efforts to put this point across, I have no better allies than NCB advocates, lactivists and AP advocates who fall over one another in their narcissistic efforts at self-aggrandizement.

Consider this photo, which I call Narcissist with Exposed Breast at Baby Fair.

According to Elicia,the mother in the photo, who has posted it on Facebook and shared it more than 2000 times:

At the baby fair today and was sad to see tons of formula stands but none for breastfeeding so Winnie and I did some advertising ourselves:)

Classic Sanctimommy!

Instead of worrying about her own baby and herself, she is ostentatiously sad about everyone else’s babies. Therefore, she felt the need to use her child in a planned publicity stunt to demonstrate her own superiority as a mother.

She packed up her baby, flowered wreaths, and photographer, and headed off to the baby fair to “advertise.” No fooling. (The flowered wreaths are a nice touch, graphically conveying the immaturity and magical thinking of Elicia and many of her fellow lactivists.)

And, as is typical for NCB advocates and lactivists, she used her baby as a prop. I suppose it is possibly that Winnie became hungry after seeing the Enfamil logo, but I suspect Elicia shoving her breast into Winnie’s mouth in front of the Enfamil logo had nothing to do with Winnie’s need for nourishment and everything to do with Elicia’s need for attention.

In classic Sanctimommy fashion, Elicia makes sure to declare that she is so not judging any other mothers.

Please remember that this is NO attempt to knock any non breastfeeding Mammas, it is to support breastfeeding as unfortunately it is breastfeeding – and nursing in public that needs our support and societies views changed. SHARE and support breast feeding!

Bullshit!

This photo is a deliberate, elaborately staged effort to denigrate formula feeding women. That’s how Elicia feels better about herself; she denigrates other mothers. Indeed, she is so desperate for self-affirmation that she conceived, planned, carried out, photographed and distributed this tableau. This is not about breastfeeding, this is not about babies, this is not about formula. This is about attempting to fill the pathetic lack of self-esteem of Elicia and lactivists like her.

The one I really feel sorry for, though, is Winnie. Imagine being reduced to nothing more than a prop in her mother’s desperate search for affirmation and attention.

There is one good thing to come out of this photograph, though. Years from now Winnie will have no need to explain to her therapist the narcissism of her mother. She can simply show the photograph, which says it all.

There is really no limit to the chutzpah of homebirth advocates.

Case in point:

Took castor oil at 41&2 and had contractions 2-3 min apart starting at 10 pm until I delivered the next day, Friday 7/26, at 5:15 pm. My first labor was only 12 hours, start to finish, so this really shocked us all… Delivered that way [half squat] with my midwife supporting my perenium. It is a boy! He was lifeless & they had to work to het him to pink up. He had apgars of 5/6/8 but swallowed fluid, had retractions in his abdomen, & would stop crying. After 30 min, they new he needed to be.transferred. I couldn’t pee & needed to be catheterized & stitched up had a 2nd degree tear all along my episiotomy scar.

The baby had to spend several days in the NICU but is now, apparently, fine. The folks in the NICU saved her baby’s life, but she’s mad at them.

Spent 2 days fighting them in the nicu & another in the less unit (they wouldn’t discharge us) I feel like he was abused & tramatized in there …

The NICU traumatized the baby? How about his own mother who nearly killed him for no better reason than bragging rights. She hired a midwife so incompetent that she had no idea she was about to deliver a lifeless baby. She labored at home without adequate monitoring. She let her baby spend hours nearly asphyxiating. She insisted on delivering far from the people and equipment that could have resuscitated the baby faster and possibly prevented a long NICU stay.

. I can’t shake this feeling that I really fucked up & shouldn’t have had a homebirth 🙁

Ya think?

There’s a lot she and other homebirth advocates can learn from this story:

1. Trusting birth is not a plan for success, but a plan for disaster.

2. A previously easy vaginal birth is not a guarantee that the next birth will be easy.

3. Homebirth midwives are incapable of assessing the wellbeing of babies. They typically have no idea what is going on until the baby drops into their hands half dead.

4. The NICU will save your baby’s life, but the people in it won’t be happy with the fact that you risked and nearly lost your baby’s life. They may well treat you as if you let your baby unsupervised to fall out the window, because that’s the equivalent of what you did. You left your baby totally unmonitored and “trusted” that nothing bad would happen. That strategy works no better with birth than with windows.

5. Don’t like the way your baby was treated? YOU were the proximate cause, not the NICU staff. He probably would never been in the NICU at all if it weren’t for your insistence on having a homebirth. I am not excusing anything less than 100% professional behavior toward the baby, but YOU put him in the NICU, so you bear some responsibility for his experience.

These incidents happen over and over and over again, and over and over and over again, both homebirth midwives and homebirth mothers refuse to take responsibility. Will the midwife undergo peer review for this disaster? Unlikely. Will she be required to have additional training in monitoring babies during labor? Almost certainly not? Will MANA, the organization that represents homebirth midwives, review its requirements in light of the unacceptably high rate of death and injury at homebirth? Not in this lifetime.

No doubt this mother would claim that she “educated” herself about homebirth and “takes responsibility” for her own medical decisions, but she hired an incompetent provider, labored in a place far from emergency assistance and then fought with the people in the NICU who were trying to save the baby’s life.

Proving yet again that you can’t become “educated” by reading the propaganda spewed forth by homebirth websites, homebirth midwives and homebirth advocates. And whining that the people in the NICU who saved your baby’s life traumatized him after you nearly killed him is the exact opposite of taking responsibility.

Feel free to copy and repost everywhere.

Injuries and accidents resulting from drunk driving are a serious problem in this county, and many states extend liability for drunk driving injuries and fatalities to the persons or bars who provide the alcohol used in the hours preceding a crash. This 3rd party liability is known as social host liability laws (when the supplier is a host) or dramshop liability laws (when the supplier is a bar). These laws recognize that the person or business that facilitated the drunk driving bears responsibility for the outcome.

I hereby offer my proposal for using 3rd party liability laws to hold homebirth midwives responsible for homebirth deaths under the theory that the person or business who facilitates a homebirth against medical advice bears responsibility for the outcome.

Mothers Against Drunk Driving explains the rationale behind social liability laws. According to MADD, dramshop laws:

• Reduce alcohol-related crashes
• Increase publicity of the impacts of over-serving
• Decrease excessive and illegal consumption
• Do not decrease personal responsibility

Note that these laws do not imply that the bar caused the drunk driving accident, merely that by selling alcohol to someone obviously drunk facilitated the accident. They do not discount the role of the person who chose to drive drunk; they merely recognize that when people are drunk, their ability to make informed and rational decisions is impaired.In other words, they recognize that 3rd parties who facilitate drunk driving have a responsibility to prevent reasonably foreseeable consequences.

Obviously, the analogy between drunk driving and homebirth is far from perfect, but the similarities are striking nonetheless:

• Homebirth midwives (like social hosts and bars) generally do not cause deaths directly.
• Homebirth midwives (like social hosts and bars) don’t intend that deaths occur.
• It is entirely possible that the injuries or deaths might have occurred anyway even if the homebirth midwives (like social hosts and bars) were not involved.
• Homebirth midwives (like social hosts and bars in drunk driving) facilitate the behavior that leads to the injuries or deaths. It is generally their behavior (agreeing to attend homebirths, encouraging homebirth in high risk situations, deliberately supplying inaccurate medical advice, and failing to transfer patients in a timely fashion) that encourages women to ignore real, accurate medical advice.

The theory that undergirds 3rd party liability alcohol laws is straightforward. By holding bars and hosts responsible for the results of providing alcohol, it gives them a stake in the outcome. Before serving a drink to an intoxicated person, the bar or host must weigh the possibility of paying money or going to jail if serving alcohol leads to injuries or deaths.

Similarly, the theory that undergirds 3rd party liability laws for homebirth midwives is also straightforward. By holding homebirth midwives responsible for the results of encouraging homebirth against medical advice, it gives them a stake in the outcome. Before encouraging a woman to have a homebirth, or agreeing to attend a homebirth, or claiming that conventional medical advice is wrong, the midwife must weigh the possibility of paying money or going to jail if the homebirth leads to injuries or deaths.

The anticipated advantages?

• Reduce homebirth deaths
• Increase publicity of the impacts of homebirth against medical advice
• Decrease homebirths against medical advice
• Would not decrease personal responsibility of women choosing homebirth

Currently homebirth midwives bear no responsibility for homebirth deaths, because they are “judgment proof.” It is nearly impossible to recover the cost of a lawsuit from a homebirth midwife because they have no insurance. 3rd party liability laws would mean that midwives could be fined or sent to jail without the need for filing an expensive malpractice lawsuit.

Currently, because they bear no responsibility, there is no downside for homebirth midwives to encourage high risk mothers to give birth at home. By insisting that homebirth midwives have a stake in the outcome of homebirth, I suspect we could dramatically reduce the number of homebirth midwives dispensing false medical “advice” or providing encouragement of high risk homebirth. Most importantly, we could dramatically reduce the number of preventable homebirth deaths.

Houston, we have a problem.

There’s a new kind of toy on the block, and it’s difficult to imagine a more damning indictment of the way we treat children.

I’m talking, of course, about “snack toys.”

No, not the little toys that come with fast food; these toys:

Keeping a child amused for hours on end isn’t the only aim of toy makers. They are increasingly creating playthings aimed at busy kids who only have bite-size bits of time to play—a trend some in the industry are calling “snack toys.”

School-age children are increasingly playing in short bursts of time between organized activities—whether on the sidelines of a sibling’s soccer game or at home, between piano lessons and homework…

Apparently, today’s children are so overscheduled that they don’t have time to play a board game.

Hasbro Inc., the world’s largest board-game maker, has spent the last several years reconfiguring classic board games, including Monopoly, Scrabble and Boggle, into versions that take less time to play and have a more frenetic pace. Unlike with traditional Scrabble, it takes just two minutes and 30 seconds for two players to complete a round of Scrabble Flash ($29.99), where the object is to make as many three-, four- and five-letter words as possible from five electronic tiles. The tiles beep when a 75-second turn is complete and light up when a legitimate word is spelled.

“Parents and children tell us they want a quick in-and-out, frictionless gaming experience,” says Jonathan Berkowitz, vice president of marketing at Hasbro. “That’s the snackable component.”

Frictionless? What does that even mean in this context?

If children now have so little time to play that Scrabble has been reduced to 150 seconds, we have a serious problem as a society. Why? Because spontaneous play is critical to child development.

According to Fergus P. Hughes, emeritus Professor of Human Development and Psychology:

Play is the most natural of childhood activities and one of the most frequently observed… [T]he criteria used to define play typically include freedom of choice, personal enjoyment, and a focus on the activity as an end in itself rather than on its outcomes. Freedom of choice seems to be an essential component of a definition of play. As Vandenberg (1998) expressed it, “The excitement of play results from the sheer exercise of freedom over necessity.”

Moreover:

Research on children’s intellectual development indicates that a number of cognitive skills, including measurement, equivalency, balance, spatial concepts, conservation, decentration, reversibility, and logical classification are enhanced during play, and particularly during the course of symbolic play. In addition, symbolic play is thought to afford children the opportunity for creative expression, as well as to actually facilitate creative processes, including divergent thinking.

The implications of “snack toys” are distressing at best and chilling at worst.

Why have we created a world where children are so scheduled, have so little time for themselves, and so little agency to choose extended spontaneous play they there is a need to amuse them in bite sized bits of time?

Who benefits by children being so scheduled, with so little time for themselves and their own play, that there is only time for “snack toys”? It’s not children!

We claim to want children to develop creativity, critical thinking, especially to learn how to “think outside the box.” Yet our actions belie our words. Children who have only time enough for “snack toys” don’t have time for creativity or critical thinking and certainly aren’t going to learn to “think outside the box” when their lives are so controlled that even their play comes out of a box in bite size pieces.

I don’t have the solutions for the problems that we are facing, but I do know this:

If children don’t have enough time for spontaneous creative play, they don’t have enough time for the learning, growth and development critical to childhood. Instead of creating “snack toys,” we should be creating more opportunities for spontaneous creative play.

Our children deserve nothing less.

It is a terrible thing when science is hijacked by ideology.

That’s what has happened to the science of breastfeeding, where breastfeeding proponents are falling all over themselves to “prove” that breastfeeding increases IQ. The latest paper in the genre is Infant Feeding and Childhood Cognition at Ages 3 and 7 Years; Effects of Breastfeeding Duration and Exclusivity, by Belfort et al., published yesterday in JAMA Pediatrics.

The study was hyped on NBC.com:

Young children who were breastfed as infants scored higher on intelligence tests than formula-fed kids, and the longer and more exclusively they were breastfed, the greater the difference …

The researchers found that 7-year-olds whose moms had done any breastfeeding during the child’s first year – exclusively or in combination with formula – gained a little more than a third of a point in verbal IQ for each month of breastfeeding compared to children who were never breastfed. That means if the mom did any mix of breastfeeding for the entire 12 months, the gain would be 4.2 verbal IQ points

That sounds very impressive, but, in reality, is basically meaningless. Why?

Suppose I told you that Jane has an IQ of 109 and that Mary has an IQ of 113. And suppose I also told you that the standard error of measurement in IQ tests is approximately 3 points, meaning that Jane’s “real” IQ is between 106 and 112, and Mary’s IQ is 110-116.

Would you conclude that Mary is “smarter” than Jane? Would that mean that Mary would necessarily get better grades than Jane in high school or college? Would it mean that Mary would necessarily have a higher SAT score than Jane? Would it mean that Mary was destined to have greater professional success than Jane?

The answers, of course, are no, no, no, and no.

Indeed, if Jane and Mary were sisters, there would be no way that anyone, including their parents, could identify which girl had the higher IQ. Given the standard error of measurement of the test, it is entirely possible that Jane and Mary actually have the same IQ since, theoretically, both could have a real IQ of 110.

In fact, the study also showed that breastfeeding had no impact on scores of two other tests, WRAVMA (Wide Range Assessment of Visual Motor Abilities) and WRAML (Wide Range Assessment of Memory and Learning), tests of actual skills.

In other words, the study showed that the gains in IQ were trivial and did not translate to a measurable difference in performance on tests of learning and memory.

That doesn’t even take into account the limitations of the study itself (fully 1/3 of children were lost to followup and simply ignored) or the effect of publication bias, which Wikipedia defines as:

a bias towards reporting significant results, despite the fact that studies with significant results do not appear to be superior to studies with a null result with respect to quality of design. It has been found that statistically significant results are three times more likely to be published than papers affirming a null result.

In other words, a study that shows that breastfeeding increases IQ is 3 times more likely to be published than a study that shows breastfeeding provides no benefit in IQ even though the second study may be of equal or higher quality.

I expressed my skepticism of this study to the Wall Street Journal:

Dr. Amy Tuteur, an obstetrician who writes a blog called skepticalob.com, is unconvinced by a four-point increase in IQ, saying the bump needs to be bigger to prove that it isn’t just random variation. “Intelligence is multifactoral and the idea that any one thing can make a big difference right away makes me skeptical,” she said. “American IQ has been increasing steadily, it rose when breast-feeding rates were going down and it rose when breast-feeding rates were going up.”

What the real take home message of this study?

It’s exactly the same as the take home message of all the other over-hyped studies that purport to show that breastfeeding increases IQ:

The impact of breastfeeding on IQ is trivial and has no measurable effect on learning, memory or achievement.

In other words, this study, which will be used as a cudgel by lactivists to shame women who don’t breastfeed, actually provides tremendous reassurance. There is NO need to feel guilty about not breastfeeding, since there is no clinically apparent benefit in achievement.

… even when your baby dies at homebirth.

From Midwifery Today:

One week ago I lost heart tones on our little girl at 9 cm. We rushed to the hospital but we weren’t on time and they did a cesarean. Because of a long labor (4 days) and not dilating (transition for 15 hrs) the dr told me I shouldn’t labor again. However, I’m planning on having another baby as soon as I can and would like a home birth.

Could I tap into your experience and get suggestions for building up my body to have a healthy baby and birth experience next time?…

The responses represent the usual Midwifery Today inanity:

Shannon Mitchell: Sweetheart, this was most likely not a function of size or location or any of a thousand things… I will say ..trust yourself. Mourn. Grieve. Believe in yourself as you move forward because that is what allows you to think clearly without fear and know the right choices to make. I’m so sorry that this little one did not stay to meet you in person and grow here on earth but I’m glad you got to know her in the time you did.

Ummm, she trusted herself the first time to know the right choices to make and she made the WRONG choice. Why would you advise her to know the right choice now?

And:

Heather Baker:… this is one of those times where I believe in herbs w a long labor. homebirth is fine to try again. stay away from bread so baby isnt as big and take vitamins prior to and during pregnancy.

Herbs would have kept the baby from dying?

And:

Khadijah Cisse So sorry for you loss (and for any hurtful comments you will get for staying home). You are a strong woman. You should try to birth however you choose. Size was not likely the issue. Head position was the likely culprit…

Head position was the culprit in this baby’s death?

And this gem of stupidity:

Jessica Landers: … I believe you are capable of a homebirth. I suggest you get health. Work out and get yourself fit. Continue working out throughout your pregnancy. A toned and strong mother will have an easier time of delivery.
follow the Brewers pregnancy diet. Seriously, it is awesome!
A combo of herbs as a tea will provide uterine to.e, healthy blood, and many beneficial vitamins(nettles, red raspberry leaf, dandelion root, alfalfa, oat straw,rose hips, spearmint) .

Evening primrose oil capsules can be inserted vaginally at 36 weeks and on. It will help to soften your cervix.

And this hideous “advice”:

The Pink Kit Method For Birthing Better®: I don’t know whether to be outraged by this story or deeply saddened. This story should tell everyone that 1) this woman did not have the skills to prepare her pregnant body to be a birthing body nor the skills to work through this birth 2) that this woman probably birthed at home for an ideological reason and had not boundaries within herself when it was appropriate for her to seek medical care. She obviously was ok with medical care because she eventually went to hospital and had a c/s.

Here’s the thing. Giving birth is both safe and not safe no matter where a woman gives birth, who attends or what is happening to or around her…

Midwifery Today is a tremendous source of comedy gold… or it would be if babies weren’t dying preventable deaths because morons like these “advise” each other.

My suggestions:

Have your baby in a hospital with a doctor, an operating room, and a neonatal intensive care unit, not as home with a clown who calls herself a midwife.

And in the meantime, stop listening to effluvium discharged by the fools at Midwifery Today.

Yet another battle of wits with unarmed opponents.

Ohmigod! Ohmigod! Ohmigod! Dr. Amy will be speaking in a venue where we can’t delete her or ban her. What to do? Duh, try to censor her, of course!

Thus saith self-proclaimed “public health scholar” Gina.

Lots of homebirth advocates are afraid of me. My personal favorite explanation comes from Katie Prown. It’s a blast e-mail sent out by The Big Push for Midwives, bemoaning my influence, because of my:

highly negative, but to the average person, highly plausible, comments.

Highly negative and highly plausible … and highly accurate.

Why are homebirth advocates so afraid of me? Navelgazing Midwife said it best:

It’s really important for people to know that Dr. Amy isn’t going anywhere and that she will continue to be used as a source protesting Certified Professional Midwives and much of home birth. I know women who begin reading an article or post and if Tuteur is mentioned, abruptly end their reading session. Dr. Amy has been a source in over a dozen articles, from the Los Angeles Times, the New York Times and Time.com; it’s unlikely she’s going anywhere…

As much as Dr. Amy Tuteur makes some people crazy, she has proven she is not a force to ignore. While I have issues with her delivery and am unsure about all she professes as fact, the woman has things to say that need to be heard and she’s going to be heard, whether we like it or not…

As one commentor on NGM’s site noted:

I am profoundly uncomfortable with all the Amy-bashing that goes on. Granted, the woman is strident, vocal, and opinionated, but what the heck?, since when are we all supposed to be shrinking violets? I suspect that she makes people profoundly uncomfortable because she zeroes in on all the stress points in midwifery care like a homing missile. Uneven/inadequate training? Check! Lack of accountability? Check! Absence of informed consent, good backup, timely transport? Check, check, check! She pushes people to address issues they’d rather gloss over. And THAT in my opinion is why she is so reviled.

It’s the same reason why every major professional homebirth advocate refuses to debate me. They know the facts are on my side. They know they’d be eviscerated in very short order.

And as NGM pointed out, I’m not going anywhere. If you’re a homebirth advocate constantly spewing nonsense, you should be very, very afraid.

I could almost feel sorry for natural childbirth advocates. They have such low self-esteem and are so desperate for validation of their own beliefs, they have resorted to pretending that Duchess Kate mirrored their own birth choices.

The Duchess may be the wife of one heir to the throne and the mother of another, but even she cannot escape the pathetic need of natural childbirth advocates to judge and demean. The Duchess has modeled the best way to handle natural childbirth advocates; she has ignored them and refused to reveal private details of her pregnancy and birth. Therefore, NCB advocates have been forced to resort to pretending.

It started as soon as the pregnancy was announced. Twitter was full of NCB advocates fantasizing the the Duchess would have a homebirth. Unfortuntately for them, that was never in the cards. The Duchess, like any mother anxious to get the best possible care for herself and her child, gave birth in a hospital, and with obstetricians, not midwives. It seems as though when it’s REALLY important to ensure the survival of mother and baby (because they are part of the royal family), midwife led care is viewed as unacceptably second rate.

Oh, well. At least they can still pretend that the Duchess insisted on a natural birth. Despite having no idea of the Duchess’s due date, NCB advocates waxed rhapsodic that she didn’t have a post dates induction. Unfortunately, even an obstetrician I respect fell for that gambit. (The great Kate wait is a lesson for maternal health providers and pregnant women alike, as if the Duchess’s obstetricians would have hesitated for a microsecond to induce or proceed to immediate C-section if there were even a tiny hint that the little prince were at risk of oxygen deprivation.

Since the birth Twitter has been buzzing with NCB advocates speculating about whether the little prince had delayed cord clamping and whether he was or will be circumcized. It is assumed that the Duchess will breastfeed, so speculation centers around whether she will breastfeed in public (not likely).

But for sheer desperation and idiocy, you can’t beat today’s piece by Dr. Miriam Stoppard in the Mirror, Royal baby news: Kate Middleton’s quick childbirth shows she was relaxed during labour.

News the birth was quick suggests Kate was relaxed and not anxious during labour.

She apparently used a method called hypnobirthing to stay calm and visualise a straight forward birth.

Having Prince William at her side coaching, supporting and reassuring her during labour must have made a huge difference…

I hope the midwife laid the baby on Kate’s stomach soon after the birth so he could hear her heartbeat and smell her skin…

I guess if you are going to fantasize, you might as well go all the way and pretend that the birth was attended by a midwife even though it was reported that it wasn’t.

Stoppard has absolutely no idea how long the Duchess’s labor lasted since she doesn’t know when it started, but no matter. It’s so much more satisfying to pretend that it was quick and easy.

Stoppard has no idea whether or not the Duchess was relaxed or why. “Relaxing” during has no impact on length of labor and there is no scientific evidence that hypobirthing benefits anything other than the wallets of hypnobirthing purveyors.

For all we know, the Duchess received an epidural the minute she came through the door, and relaxed in comfort until the baby was born. But who cares about reality when pretending provides a much better boost to fragile self esteem.

You know what I didn’t see in the months leading up to the royal birth and in the days since? I haven’t seen anyone other than NCB advocates speculating about the details of the birth. I haven’t seen any women fantasizing that the Duchess would have an epidural like they did, or would opt for a maternal request C-section, or would request active managment of the 3rd state of labor. Most women don’t need anyone, not even a Duchess, to validate their childbirth choices.

Which makes it even more remarkable that natural childbirth advocates apparently need everyone to do so.

Freudian slip?