I have a thought experiment for those decrying the fact that I highlighted a woman’s publicly proclaimed justification for choosing homebirth again after her first child suffered serious brain damage during homebirth.

What if the same woman had written “Drunk driving after brain damage” and it went something like this:

Unlike most drunk drivers whose choice has hurt others, I can honestly say that I worried very little about a reoccurence. I recognized the situation with Joshua [the car crash that resulted in his brain damage] for what it was, a rare and random event that was bad luck, and I had no doubt that it would not happen again. When I imagined driving drunk with Amelie, my second child, I imagined everything going well. The main point of difference for me, was that when I was driving drunk with Joshua I was 100% confident that everything would be fine, I knew sometimes people could have bad outcomes but I never imagined that could happen to me. After Joshua’s brain injury, I knew that it could.

She learned how to prevent something similar from happening a second time:

I consulted with an expert on drunk driving. He basically said that the only real guarantee to prevent brain damage from drunk was if no one ever drove drunk, and we all know that will never happen.

She cannot imagine attending parties and not getting drunk:

Despite what happened with Joshua, I still believe all of the things that I believed about my driving before having him. I still think I can hold my liquor. I still think that I am a fine driver even when drunk. I still want to drink at parties, I still want to avoid taxis, and I still think I will be happier at parties if I am drunk. I have seen several of the taxis in my town… I still cannot imagine how a woman takes taxis instead of driving herself home.

Would you think she was selfish?

That might sound selfish, and I guess it is a bit, because primarily I am thinking about what is going to make a party experience LESS awkward for me. And to me the answer to that is drinking at parties. Some people want access to another driver so a taxi is the clear choice for them… For me, I don’t want it… I am WAY more scared of being in a taxi than I am of driving drunk…. so its important to me that I can be in an environment where I can deal with things the way I feel like it and not be bothered or subjected to taxi drivers’ whims.

Or would you be appalled by her narcissism?

There was never any doubt in my mind after the accident with Joshua, that I wanted to continue drinking at parties. That I wanted to continue driving home drunk.

Understandably, having had a child with brain damage due to a drunk driving accident many women feel worried about driving drunk in the future. That small risk feels very, very scary the second time around and the majority of women feel safest in making choices very different to mine. They WANT to take a taxi. They WANT to have a designated driver. They WANT stop driving drunk. (Many brain damage cases, including Joshua’s, are caused by an injury while driving drunk… so many women wish to avoid driving drunk ever again.) I don’t judge anybody for feeling that way. When you have been through a drunk driving crash, you really need to do whatever feels safest to you, whatever option is going to be the best one for your mental health is the right option. I just happen to be the opposite to most women in my situation… and feel that the right choice for me is drinking at parties and driving myself home.

Is this woman entitled to our compassion because her son was permanently brain injured by her choice to drive drunk? Or is her son really the one who is entitled to our compassion?

Is this woman “off limits” for criticism of subsequent actions because her child paid a devastating price for her decision to drive drunk? Or does she merit our criticism even more because she refuses the learn from her first accident?

Does the fact that she feels happiest drunk mean that it is acceptable to drink and drive? Is it really about what makes her happiest or is what is safest for all involved more important?

Leaving aside the issue of addiction for a moment, the decision to drink and drive is a sign of narcissism. It reflects the fact that, when all is said and done, the drunk driver feels that her need to get drunk is so important that it trumps everyone else’s safety. Moreover, most drunk drivers actually believe that they are great drivers when drunk and don’t consider themselves a risk for future crashes.

Would you hesitate to criticize a woman who chooses to continue to drive drunk despite the fact that her oldest child suffered a permanent brain injury during a drunk driving crash? What’s the difference between that and choosing a homebirth (with the exact same risk factors and the exact same attendant) after her oldest child suffered a permanent brain injury at homebirth?

Does homebirth encourage narcissism or do narcissists choose homebirth?

There’s no question that homebirth encourages narcissism by creating a false equivalence between a mother’s experience and a baby’s health, brain function and life. I will admit that it is unfathomable to me that any woman would think that her experience is anywhere near as important as whether her baby lives or dies, but not only does homebirth encourage that view, it promotes that view by dramatically minimizing the risks of homebirth and dramatically overstating the benefits.

But I know of no professional homebirth advocate who claims that a birth experience is MORE important than a baby’s health, brain function or life. That’s intrinsic narcissism on the part of the mother.

Consider the mother who gives birth to a baby with significant brain damage as a result of homebirth, but chooses to have another homebirth. The mind boggling narcissism of this mother shines through almost everything she writes.

In announcing the birth of her daughter (Homebirth after HIE), Karissa writes:

Unlike most HIE parents, I can honestly say that I worried very little about a re-occurance. I recognised the situation with Joshua for what it was, a rare and random event that was bad luck, and I had no doubt that it would not happen again. When I imagined Amelie’s birth in my head while I was pregnant, I imagined everything going well. The main point of difference for me, was that when I was pregnant with Joshua I was 100% confident that everything would be fine, I knew sometimes people could have bad outcomes but I never imagined that could happen to me. After having Joshua, I knew that it could…

What happened to Joshua?

You can read the full story on the blog, but the basic story is that intermittent auscultation revealed fetal distress, the mother transferred to the hospital, the baby was delivered immediately, and began having seizures within an hour of his birth. Joshua now has secondary microcephaly (small brain) and cerebral palsy.

Karissa is quite clear that it is the labor that led to Joshua’s brain damage. She sent his records to someone she describes as a specialist in hypoxic ischemic encephalopathy and received the following assessment:

We spent TWO HOURS on the phone this morning discussing it all. Firstly, he talked me through the results of the neuro-imaging reports.

Firstly, an Ultrasound of his head was done on the day he was born. The results of this were normal. Dr Hill said the main purpose of this ultrasound is to identify bleeds in the brain that would require immediate action. None were found, and that is about the scope of ultrasound imaging… it is not as detailed as other scans like CT and MRI. MRI is the best form of imaging.

Joshua suffered widespread brain damage:

Joshua’s MRI was done at 5 days old, which, from a clinical point of view, allows enough time to see what damage has occurred… They made reference in the report to the Peripheral brain, which he said that his interpretation of that would be the outer layers of the brain were where these signal abnormalities were at their worse, but although affected, the temporal/parietal regions showed less of a problem than the other areas. Overall though, the damage was all encompassing, which he believes is consistent with a generalised decrease in blood flow. Brain damage can also be focal, affecting only a specific area, but in Joshua’s case, it was the whole lot.

A follow up CT scan revealed the extent of the damage:

A CT scan which was done at 5 months of age showed Encephalomalacia in the right parietal region and atrophy/hypoplasia of the frontoparietal regions of both cerebral hemispheres. Encephalomalcia basically looks like cysts in the brain… it occurs because brain tissue has died, and the pockets of dead cells are surrounded by healthy tissue…. the pockets fill with cerebral spinal fluid and appear like a cyst.

Why did this extensive brain damage occur?

As far as timing of the injury goes, he believes it happened during the labour and delivery period. The biggest indicator of that, is the fact that Joshua was born with a normal head circumference on the 50th percentile. If for example, the problem occurred a month before he was born, we would not expect to see a normal head circumference at birth. Joshua had a normal head circumference which then failed to grow normally in the neonatal period. Indicating that the problem occurred very close to the time of birth…

Dr Hill believes that the most likely cause is intermittent, transient umbilical cord compression…

There is one other possible explanation for this kind of episodic problems with blood flow, and that is utero-placental insufficiency. Where basically, the blood vessels connecting the uterus and the placenta are not as healthy as they should be and cause problems with blood flow…

In other words, Joshua was deprived of oxygen during labor. Even though Karissa transferred to the hospital once her midwife figured out the danger, it was too late. What does Karissa take away from this?

He basically said that the only real guarantee to prevent brain damage from a cord compression was if every woman was on continuous fetal monitoring for her entire labour and delivery and it was able to be detected immediately. This is not standard practice.

It’s not standard practice when the fetal heart rate is completely normal, but it IS standard practice once an abnormal heart rate is detected. Had Karissa been in a hospital during her labor with Joshua, she would have had continuous monitoring at the first sign that anything was wrong. She almost certainly would have had a C-section once continuous monitoring revealed recurrent heart rate abnormalities. Although there is no guarantee that Joshua would have escaped without any brain damage, the amount, and therefore his deficits, would have been smaller. Short version: this could have been diagnosed and treated in a hospital.

But what’s more important, Karissa’s experience or a baby’s brain function? Karissa explains her “reasoning” in choosing homebirth again.

She’s learned nothing from her first experience:

… Despite what happened with Joshua, I still believe all of the things that I believed about birth before having him. I still want a natural birth, I still want to avoid common and unnecessary interventions, and I still think I will be happier in an environment that I am comfortable in. I have seen several of the rooms in the Delivery Suite at the hospital… Joshua was ultimately born in one, and I still cannot imagine how a woman spends hours in one of those rooms. I literally turned up and got the baby out…. But having to labour there?

Her experience is more important than anything else.

That might sound selfish, and I guess it is a bit, because primarily I am thinking about what is going to make a painful experience LESS painful to me. And to me the answer to that is being at home. Some people want access to pain relief so a hospital is the clear choice for them… For me, I don’t want it… I am WAY more scared of having a needle in my spine than I am of the actual pain…. so its important to me that I can be in an environment where I can deal with things the way I feel like it and not be bothered or subjected to hospital policies.

She is mind bogglingly narcissistic.

There was never any doubt in my mind after having Joshua, that I wanted my next baby to be born at home. That I wanted the chance to have the birth that I wanted, but missed out on with Joshua…

She recognizes that other women would not take the risk of subjecting another baby to major brain damage and life long deficits, but that’s not how she feels.

Understandably, having had a child [with HIE} many women feel worried about going on to have another baby. That small risk feels very, very scary the second time around and the majority of women feel safest in making choices very different to mine. They WANT to be in a hospital. They WANT extra monitoring. They WANT an elective C-section. (Many HIE cases, including Joshua’s, are caused by an injury during labour… so many women wish to avoid labour completely) I don’t judge anybody for feeling that way. When you have been through a traumatic birth experience, you really need to do whatever feels safest to you, whatever option is going to be the best one for your mental health is the right option. I just happen to be the opposite to most women in my situation… and feel that the right choice for me is going on to have a “normal” birth.

Narcissism and denial go hand in glove

I was quite amused recently, looking at the blog of a Obstetrician who is very ANTI home birth and was tipped off to the birth story of a woman who frequents one of the same forums as I do. She put her birth story out on a public forum, and this Dr took it and pulled it apart on her blog. It was titled “You risked your Baby’s brain function for this?”. Sadly, this woman’s midwife made some very questionable decisions, but eventually a hospital transfer was made and Baby was born in the hospital. Very traumatic experience for the Mother, but thankfully the baby is ok.

I got to browsing this blog after being made aware of it due to this unfortunate incident, and this is where the amusement comes in. This very Doctor, who wants to bash women who plan home births (She has another separate blog just for home birth horror stories by the way) has many entries on her blog about the kinds of negligence that takes place in hospitals… It seemed very unusual to me for someone who is so pro-Hospital, to also be highlighting the sometimes very serious mistakes that take place in a hospital. Her blog certainly did nothing for me in terms of making the hospital sound like a safer choice!

So after playing Russian roulette with her first baby’s brain … and losing … she figures it’s okay to play Russian roulette with her second baby’s brain. What are the chances that there will be two bullets in the cylinder?

Fortunately, this baby appears to have survived her mother’s extreme self-absorption. But, nonetheless, there was another bullet, albeit considerably smaller. Karissa had to transfer to the hospital for suturing of a perineal laceration and mild obstetric hemorrhage.

Oh, well, maybe third time’s the charm.

It’s getting harder and harder to parody natural childbirth and homebirth advocates because there is virtually nothing I can write that is more absurd than how they actually behave. No sooner did I finish yesterday’s satire on the Sanctimommy Olympics, joking that a gold medal performance in birth does not require the baby to survive, then someone sent me a link to this thread on Baby Center, posted on 8/3/12:

So I had a successful VBAC 6 weeks ago, yay!

but… my baby went into distress during pushing, and when she was born she had several issues, meconium, trouble breathing, high acid levels, and had to stay in the NICU for 3.5 weeks. She was diagnosed with HIE, so she had a severe lack of oxygen at some point, and an MRI showed brain damage.

So what I’m posting for is to ask if anyone else has has the experience of a sucessful VBAC, but an unhealthy baby, and how to I deal with the conflicting emotions about that??

On the one hand, I’m so happy I was able to experience a drug free labor and push my baby out (with some necessary assistance at the end, but still), that was something I wanted so badly, and I’m proud I was able to handle drug free labor so well.

And on the other hand, my baby couldn’t handle a vaginal birth for some unknown reason and she will probably have to deal with the effects of that for the rest of her life. So I feel like I really shouldn’t be so proud of that VBAC, like I should have just had a RCS instead.

help? 🙁

In response, I’ve promulgated this handy rule of thumb:

It is not a success, and you are not entitled to be proud, if the birth results in a dead or brain-damaged baby.

You know why? Because your birth experience is WORSE THAN MEANINGLESS compared to the health of your baby’s brain or body! No doubt the natural childbirth and homebirth narcissists will be shocked to learn that there is anything that matters more than their personal experiences, but that’s our typical response to behaviors that maim or kill others.

You may love the experience of drag racing and winning, but if the other driver is killed in the process, you have no right to be proud. You might love the experience of giving your unsecured toddler a ride on your motorcycle, but that doesn’t make up for the fact that he died when thrown from the bike. You may hate visiting a hospital, but that won’t excuse you from failing to bring in your deathly ill child.

Lest you think VBAC complications are vanishingly rare, consider that two other women reported uterine ruptures on the same thread:

I am SO sorry you had to go through this. I also had a complete uterine rupture back in March. My story sounds so much like yours. I’m here if you ever need to talk, because I know how hard it is to deal with. Also like pp stated, I have a few uterine rupture support groups you can join when you feel ready. I’m praying that your baby makes a wonderful recovery <3

And:

I’m another rupture mom. We lost our baby in August last year. This is a tough and confusing time and I’m praying for you and you little one. We do have mamas in the rupture support groups mentioned by previous posters who have experience with cooling caps. When you’re ready, get in touch an we can put you on touch. Lots of hugs. Life is so very unfair.

Moreover two additional women on the same message board posted about catastrophic VBAC outcomes within the next 48 hours.

On 8/4/12, a second mother reported:

I went into labor on Wednesday morning at 3:30 am. I labored for 16 hours without an epidural. My water was ruptured when I was 8.5 centimeters dialated and 100% effaced. Two hours later I was 10 and began too push. Immediately, I began to have excruciating breakthrough pain which I now know was me rupturing. I pushed through three contractions before my son had a complete heart decel.

I was rushed in for emergency csection. I had to be given general anesthesia. When I woke up post op I was told my son was essentially brain dead and we should let him die peacefully. Within two hours of being born he began to show brain activity. He began breathing on his own, sucking, his gag reflex was intact. Based on these new developments he became eligible for a treatment known as cold cap that is for newborns with brain injuries. His treatment concludes early next and once it does we will have a better idea of his prognosis.

Mu providers are devastated. They supported a VBAC from the beginning. According to the Doxtors my VBAC was picture perfect until I began to push. In every phase of labor they were aware of my desires and supported them until it became clear there was a problem. I can’t believe I am in the .5%-1.25% that ruptures.

And on 8/5/12, a third mother reported:

Was hoping to vbac but after going into labor, water breaking, etc baby boy’s heartrate dropped to a scary level enough times that were rushed into the operating room. Baby had the cord wrapped around his neck 3 times and lost oxygen for a period of time.

6-7 hours after birth he had a seizure and was transported to a higher level nicu for treatment. He had xool cap therapy to prevent any further damage to his brain and has recovered beautifully. He might have a learning disability in the future due to some damage found on an mri but will not be able to know until he is in school.

This is day 8 in the nicu and all he has to do is nurse consistently and we can go home! Hoping that will be in 2-3 days.

This mother, at least, recognizes that her baby’s health is more important than her experience:

I am not upset I didnt get my vbac but glad baby is doing well. If we end up with another (this was baby #3) I might just go for a rcs.

Attempting a VBAC is a reasonable option in a hospital that is appropriately staffed, IF and ONLY IF a mother understands that death and brain damage will inevitably occur in some babies even if you are low risk, even if your doctor is standing right there, and even if you have immediate surgery.

And keep my handy rule of thumb in mind:

It is not a success, and you are not entitled to be proud, if the VBAC results in a dead or brain-damaged baby.

Lost in all the hype around the real Olympics, another festival is taking place in Oregon, the Sanctimommy Olympics.

The Sanctimommy Olympics, like the real Olympics, awards outstanding performances in a variety of events. Like the real Olympics, the Sanctimommy Olympics has strength events, speed events, distance events,and endurance events. Plus there are special categories for risking your baby’s life, putting your own needs ahead of that of your child and boasting of your superiority to other mothers.

For the first time ever, the opening ceremonies of the Sanctimommy Olympics were led by a man. Honorary Sactimommy Mayor Michael Bloomberg of New York City was the man of the hour, in large part because of his commitment to hiding infant formula in hospitals under lock and key. The torch was lit by Gisele Bunchen who shot to sanctimommy fame in the wake of her homebirth when she proposed a law requiring all mothers to breastfeed. The flame had traveled from The Farm in Tennessee where Ina May Gaskin had lit it naturally using a flint and homegrown, organic straw, across the US, carried by sanctimommy luminaries like Mayim Bialik and and Ricki Lake.

Entertainment was provided by a chorus of laboring women vocalizing their distress.

Security was extremely tight. Even participants were required to demonstrate that they did not have a scar on their uterus and to bring any baby boys for examination to confirm that all foreskins were intact.

Endurance events include longest out of hospital labor (extra points if the baby survives, though that is not a requirement), longest breastfeeding (minimum requirement for entry is 4 years), and most children tandem breastfed at the same time. This year the same woman won the gold medal for both longest breastfeeding and most children tandem breastfed. She is still breastfeeding her 10 year old, as well as four other children, ages 8, 6, 4, and 2.

This year also saw the introduction of two endurance events for fathers: most years excluded from sleeping in the family bed and least number of acts of sexual intercourse in a 5 year period.

The main strength event is child-wearing. Anyone can wear a baby 24/7, but it takes a real champion to wear a pre-teen. Extra points are awarded if the child has never learned to walk independently.

Speed events include rushing infants to the potty for elimination communication, dashing into traffic to rescue children who keep playing there because they have never been disciplined, and instantaneously criticizing any father who dares to evince an opinion on raising his own children. The criticism event was marred by numerous false starts of mothers who criticized their husbands even before they said anything.

The heart and soul of the Sanctimommy Olympics are the special events. These include risking your baby’s life at homebirth. Unfortunately, this year’s gold medal was awarded posthumously to a woman who died attempting an unassisted birth through a placenta previa. The baby died, too, which isn’t a problem since no points are deducted for a dead baby.

The signature special event is the Sanctimommy Heptathalon. Participants compete in 7 special events including homebirth (extra points for broadcasting it live), extended breastfeeding, extended baby-wearing, sanctimonious heckling of women who make different choices, running a blog, banning comments that disagree, and insisting that you are being persecuted for your choices. This year’s gold medalist? The Feminist Breeder, of course!

This piece is satire.

North Carolina is on track to meet or exceed the horrifying toll of 5 known deaths last year.

The first occurred in May. The second occurred in Wilmington in late May/early June. It was the result of a shoulder dystocia at an attempted HBAC (homebirth after cearean). Now comes word of a third death.

The baby boy* died on July 23, 2012. His death was reported to me by a grieving family member:

[My daughter’s] water broke in the early morning hours of Thursday July 19th…

Her doula was Rowan Bailey- a student and follower of The Matrona and Whapio Diane Bartlett, in Asheville NC

Rowan Bailey claims a holistic, non-interference approach, and she lived up to that reputation. She became annoyed at phone calls and doubts from family and the father.

After 4 days of labor, she finally admitted she did not know how to “get the baby out” at home.

At the hospital they could not find the baby’s heartbeat. The stillborn baby was born that afternoon.

Who is Rowan Bailey? According to her website:

MY PHILOSOPHY~ I believe you are inherently and intuitively aware of your requirements for yourself and your baby. You are your own creator of your dreams fulfilled. I also believe that pregnancy and birth are amazingly transformative experiences to be enjoyed with love and enthusiasm. I honor your journey as sacred and fully yours. As your consultant it is my responsibility to remind you of your power and knowledge to make your own informed choices with clarity of intellect and spirit. We will work together to co-create a nurturing environment for the entire family.

My Work: I am doing global work for peace and non-violence through my commitment to education in conscious birth choices. I co-create with families the space for powerful and transformative experiences in the child bearing year.

Her “training”?

I completed the Holistic Doula Training at The Matrona with teacher and mentor Whapio Diane Bartlett in 2003. I continued to study birth with Whapio and many others through workshops and conferences learning numerous methods and healing modalities such as Homeopathy, Herbs, Conflict Resolution, Reiki, Water Birth and Acupressure to mention but a few. I then went on to graduate from the Midwifery Immersion program at The Matrona in April of 2006. I carefully choose conferences and workshops each year to fulfill my commitment to myself and my community for continuing education. I am currently (2011 & 2012) attending Midwifery SkillsLabs and the Trust Birth Conference 2012 with Ancient Art Midwifery Institute.

Training: I was blessed to assist Claudie Cameron, DEM, for four years. During my extensive training with Claudie, I have attended the home birth of twins, breech presentation, VictoriousBAC, women who birthed premature and post-dates babies, as well as many other variations of normal. I also witnessed shoulder dystocia, hemorrhage and families experiencing grief and loss…

No doubt, she’s witnessed grief and loss. That happens all too often at homebirth in North Carolina.

And her mentor, Whapio Diane Bartlett? Apparently, she is an advocate of quantum midwifery, undisturbed birth, and placenta medicine. Her philosophy?

We feel that trusting women, nurturing women, and meeting women and their families where they at are the tools that allow us to create soul-level connections with each other. When mother and care-give experience deep soul-level connections it is not necessary to disturb the birthing process.

We believe that the study of biology without mysticism is flat. We understand childbirth to be an altered state of reality and we prepare midwives to engage those realms and to facilitate families in receiving gifts that those worlds have to offer.

Who thinks up this idiocy?

Who believes it?

Why would anyone hire such obviously ignorant clowns to preside over a life and death event like the birth of a baby?

When are we going to fine these women out of existence and jail the ones who preside over preventable neonatal deaths?

Breastfeeding and sex share something in common and it isn’t just breasts. It’s the apparently irresistible urge of some people to force their personal beliefs on other people.

The stated desire of lactivists, like those promoting the Latch On NYC breastfeeding program, to “protect” breastfeeding bears an uncomfortable resemblance to the stated desire of religious fundamentalists to “protect” virginity from the “dangers” of premarital sex, or to “protect” marriage from the unspecified “dangers” posed by gay people who deeply believe in the institution of marriage and wish to participate in it.

All three efforts share many things in common:

1. All three, breastfeeding, virginity or marriage, are in not in need of protecting by anyone.

2. All three are the business of the participants and no one else.

3. “Protecting” in this context is merely a cover for the real issue, which is forcing the personal beliefs of one group on another group who believes differently.

4. All three grossly overstate the purported benefits of protection or fabricate new “benefits” from whole cloth.

5. All three grossly overstate the purported risks of not “protecting” these practices or fabricate new “risks” from whole cloth.

6. All involve efforts to “educate” anyone who disagrees.

7. All involve shaming anyone who disagrees, often under the guise of “educating” them.

8. The people doing the “protecting” consider themselves morally superior to anyone who disagrees.

9. All three utterly ignore the opinion of those whom they are supposedly protecting. It is curious fact that efforts to “protect” breastfeeding ignore the views of those who bottle feed; efforts to “protect” virginity ignore the views of those who engage in premarital sex, and efforts to “protect” marriage ignore the views of gay people.

10. Those who wish to do the protecting face absolutely no danger from the very people from whom they are protecting themselves. Lactivists face no danger from mothers who bottlefeed; people who believe that sex should be reserved for marriage face no danger from those who engage in premarital sex; and religious fundamentalists face no threat from married gay people to their own ability to get married, stay married or enjoy marriage.

The bottom line is that all three efforts, to “protect” breastfeeding, to “protect” virginity and to “protect” marriage, aren’t really about protection at all. They are nothing more than the efforts of one group to force its views on those who disagree. Oh, and there’s one more thing they share in common:

All three should be resisted by anyone who values personal freedom and the right to decide for yourself how to live your own life.

The folks at Latch On NYC, apparently stung by the large and growing chorus of criticism, are backpedaling as fast as they can.

In my piece for TIME, Breastfeeding Wars: Why Locking Up Baby Formula Is A Bad Idea, I pointed out:

… Most mothers give a great deal of consideration to feeding methods before they have their children — their decisions are not based on their ability to access formula in the hospital. The most likely outcome of storing formula in locked cabinets is shame for mothers who ask for it, and extra, unnecessary work for nurses who have to retrieve it, monitor it and record it…

The plan to lock up infant formula has drawn particular ire and the folks at Latch On NYC are now denying that they ever planned to lock up formula.

Sometime yesterday, Latch On NYC added a page of “Myth and Facts” that, as the name indicates, purports to correct the “myths” being circulated by the critics of the initiative. As demonstrated by the webcache, this section did not exist as recently as 7:38 GMT. The addition is rather deceptive, since the policies that Latch On NYC is now denying are an integral part of its program, remain elsewhere on the website, and were publicly supported as recently as 3 days ago by an official of the program.

For example, the “Myths and Facts” page states:

Myth: The city is requiring hospitals to put formula under lock and key.

Fact: Hospitals are not being required to keep formula under lock and key under the City’s voluntary initiative. Formula will be fully available to any mother who chooses to feed her baby with formula. What the program does is encourage hospitals to end what had long been common practice: putting promotional formula in a mother’s room, or in a baby’s bassinet or in a go-bag – even for breastfeeding mothers who had not requested it.

Myth: Mothers who want formula will have to convince a nurse to sign it out by giving a medical reason.

Fact: Mothers can and always will be able to simply ask for formula and receive it free of charge in the hospital – no medical necessity required, no written consent required.

Yet these claims are directly contradicted by front page of the website as well as the initiative description, which claims that Latch On NYC will:

Limit access to infant formula by hospital staff

Moreover, Deborah Kaplan, Assistant Commissioner of the NYC Bureau of Maternal, Infant and Reproductive Health, appearing with me in a video roundtable on HuffPo, explicitly acknowledged the restrictions. At 9:10 in the video, the host specifically asks Ms. Kaplan whether formula will be locked up (my transcription):

Host: Did I read somewhere that you will have to sign out formula? Perhaps I’m mistaken about that.

Kaplan: Yes, that is correct … and let me explain. I’m glad you asked that question. It’s important to clarify. We are … When a mother comes in and she has decided she wants to formula feed her baby, that is fine; that is her decision. She will not not be made to feel guilty and she will be given that formula. And in … the main change in that situation is that right now formula is available all over the floor where the baby and the mother is and, as some mothers have said, they want … they came in and they wanted to breastfeed and they had a small problem and right away one of the staff may have given her formula instead of providing her support and letting her try to really be successful…

In other words, formula will no longer be easily available, women will have to ask for it and nurses will have to retrieve it.

It appears that Latch On NYC is responding to the massive amount of criticism by disavowing its own words, although not by changing the actual program.

The entire controversy is an object lesson in what happens when a government organization allows itself to be captured by a special interest group. The idea of locking up formula in hospitals, forcing nurses to track it, forcing women to ask for it, and “educating” them when they do, is the ultimate lactivist dream come true.

There’s no evidence that these measures will improve breastfeeding rates, but that has never been a problem for lactivists. They are all about shaming women who do not make the same choices they do. It is deeply unfortunate that Mayor Bloomberg and the NYC Bureau of Maternal, Infant and Reproductive Health allowed themselves to be emeshed in the politics of lactivism. They may be backpedaling as fast as they can, but they only look foolish as a result.

At a dinner party several months ago, one of the guests, a psychiatric social worker, asked me what I do. I explained that I blog about issues of pseudoscience in parenting. She became very excited and asked me if I had ever heard of attachment parenting. She has been seeing an ever increasing number of young mothers with depression and related issues. In her experience, the increase in young mothers with depression is related to the rise of attachment parenting, which appears to dramatically increase levels of stress, feelings of failure and social isolation.

I was reminded of her observations when I came across the paper Insight into the Parenthood Paradox: Mental Health Outcomes of Intensive Mothering by Rizzo et al:

This study was conducted to provide quantitative data on the relationship between intensive parenting and maternal mental health outcomes including stress, depression, and life satisfaction. The first hypothesis was that endorsing intensive parenting attitudes would result in greater levels of stress and depression and lower levels of life satisfaction. Additionally, as Essentialism focuses on the primacy of the mother to the exclusion of other potential helpers in the family, we expected this scale to be related to lower levels of perceived family social support. The second hypothesis was that the endorsement of intensive parenting attitudes would predict maternal mental health outcomes above and beyond family social support, an already well-known predictor of well-being.

How did they measure commitment to attachment parenting?

Recently a quantitative measure of intensive parenting attitudes has been developed. This operationalization identified five factors associated with intensive parenting: Essentialism, Fulfillment, Stimulation, Challenging, and Child-Centered. Essentialism refers to the belief that mothers are the most essential parent; Fulfillment is the belief that parents should feel completely fulfilled by their children; Stimulation involves parents providing consistent intellectual stimulation for their child; Child-Centered refers to the parents’ lives totally revolving around their children; and Challenging refers to the belief that parenting is difficult and exhausting.

They measured depression, stress, life satisfaction and family support using standard diagnostic questionnaires.

What did they find?

The belief that mothers are the most capable parent (Essentialism) was associated with higher levels of stress and lower levels of life satisfaction. In prior research, mothers have expressed difficulty selecting an alternate caregiver because they felt that no one else, including the child’s father, could provide the same degree of love, commitment, and skill. If women believe they are the most capable caregiver, they may limit help from others, a practice known as maternal gatekeeping. This may account for the lower levels of social support reported by women who endorsed essentialist attitudes…

In addition:

The belief that parenting is difficult (Challenging) was related to higher levels of depression and stress, as well as lower levels of life satisfaction. If women believe that parenting is very challenging, they may experience higher levels of stress attempting to cope with the daily demands placed on them as parents. In addition, if women believe parenting is challenging, their feelings of competence as a caregiver may be diminished resulting in decreased well-being. On the other hand, already experiencing higher levels of stress and depression may lead women to view parenting as more challenging. Either way, believing that parenting is challenging, feeling stressed, and being depressed may relate to women’s decreased satisfaction with their lives.

Finally:

Believing that parents’ lives should revolve around their children (Child-Centered) was related to lower levels of satisfaction with life. According to Tummala-Narra, when women feel they must subsume their needs to the needs of their child, they lose a sense of personal freedom, which may result in women experiencing negative mental health outcomes (e.g., lower levels of life satisfaction). In contrast, child-centered beliefs were not related to stress and depression. It is possible that if a woman’s life is child- centered, meeting the demands of her children may not seem too stressful because she has already tailored her life to meet those needs. Thus, a child-centered mother may not experience as much stress related to difficulty coping with life’s demands.

The authors conclude:

The results of this study suggest that the negative maternal mental health outcomes associated with parenting may be accounted for by women’s endorsement of intensive parenting attitudes. So, if intensive mothering is related to so many negative mental health outcomes, why do women do it? They may think that it makes them better mothers, so they are willing to sacrifice their own mental health to enhance their children’s cognitive and socio-emotional outcomes. However, research is needed on child outcomes because, currently, there is not any data to support this assumption. In fact, young children of over-involved or over-protective parents often experi- ence internalizing disorders. In addition, research clearly indicates that the children of women with poor mental health (e.g., depression) are at higher risk for negative outcomes. Given that this study found that aspects of intensive parenting are associated with negative maternal mental health, then intensive parenting may have the opposite effect on children from what parents intend.

This study comes with lots of caveats. It is small, preliminary and it hasn’t been reproduced. The issues that it raises, though, are serious and worthy of further study.

There has never been any scientific evidence to show that attachment parenting is better for children, and now there is evidence that it is worse for mothers. It may allow them to flaunt a sense of superiority, but apparently that isn’t to stave off feelings of depression, stress and decreased life satisfaction.

If you can’t access the embedded video, you can watch it here.